人工全髋关节置换术后早期假体脱位的原因及防治措施

目的:分析初次人工全髋关节置换术后早期假体脱位原因,并探讨其防治措施。方法:随访研究29例(29髋)首次THA后早期发生脱位的原因、处理及结果;并针对脱位原因分别提出相应的预防措施。结果:29例患者中,软组织张力异常17例;假体位置不良6例;假体位置不良伴软组织张力异常1例;患者活动范围超过安全范围5例。其中15例经手法复位后未再出现脱位,7例手法复位失败或再脱位行切开复位。闭合复位或开放复位后外展中立位牵引,大多数早期能获得成功。结论:分析初次人工全髋关节置换术后早期假体脱位原因,并探讨其防治措施。

Study on the Causes and Preventions of Early Dislocation in Primary Total Hip Arthroplasty

Objective:To analyze the causes of early dislocation after primary total hip arthroplasty and to explore its preventions and treatments. Methods:The clinical materials of dislocation after THA were reviewed in 29 cases(29 hips). The strength of their hip abductor musculature was tested. Radiographs (AP view) of their pelvises were measured. Results:There were 17 cases of abnormal soft-tissue tension, 6 cases of malposition,1 case of malposition and abnormal soft-tissue tension and 5 cases of over motion. Close reduction was succeeded in 15 cases,7 cases failed to close reduction for which surgical treatment was recommended. Immediate closed reduction or open reduction with cast initially could be successful in most cases. Conclusion:Low soft tissue tension, especially the weakness of abductor musculature was the most important cause of dislocation after THA. With the correct orientation of components and an enhanced capsulotendinous repair, the posterolateral approach can result in an extremenly low early dislocation rate.