髋关节置换术后假体脱位的预防

查阅近年来关于全髋关节置换术后假体脱位的原因和预防措施研究的国内外相关文献,进行回顾及综合分析.术前对病人做详细的评估、选择合适的假体;术中提高假体位置安放的准确性、术后避免容易导致脱位的活动范围可以减少术后假体脱位的发生率.通过详细的术前、术中和术后处理可以降低术后假体脱位的发生率.     

Prevention of congenital dislocation of the hip in the newborn

Routine examination and early treatment of any instability in the hips of newborns has recently been called into question after a period of universal agreement. The hips of 49,937 neonates were prospectively studied by a general hip screening. Every unstable hip--449 in 317 children--was immediately treated with a Von Rosen splint for a 3-month-period. Overall, satisfactory reduction of the incidence of established congenital dislocation of the hip (CDH) was achieved. Risk factors leading to unstable hips (sex, first birth, and breech birth) and the development of CDH (time of stabilization) were considered.     

全髋翻修术后假体脱位的预防

目的：探讨采用后方关节囊重建方法对行后外侧入路全髋翻修术后假体脱位的防治作用。方法：本组45例（47髋）经后外侧入路行全髋翻修术的患者，男20例，女25例；平均年龄65岁（55-78岁）。术中将后方关节囊与外旋肌群分别重建固定于前上方原先切开的关节囊断端和大转子顶端的软组织处，回顾性分析术后假体脱位率及脱位的风险因素。股骨假体和髋臼假体均翻修29例（31髋），更换内衬5例（5髋），髋臼、股骨翻修的分别是10例（10髋）和1例（1髋）。第1次翻修的有29例（30髋），第2次翻修的有15例（16髋），第3次翻修的有1例（1髋）。X线评估包括翻修前后下肢长度，髋臼位相，股骨偏心距、前倾角和假体松动。临床功能评价采用Harris评分。结果：45例均获随访，平均随访时间2．7年，除1例感觉前方不稳外，无髋关节感染及脱位发生，该例X线片示髋臼假体过度前倾但无脱位发生。术后所有患者双下肢基本等长，髋臼外展角及前倾角、股骨偏心距和前倾角基本恢复至初次手术前水平。髋臼、股骨假体发生松动各1例。髋关节功能Harris评分由术前平均（49.13±15．53）分升至末次随访的平均（83．59±6.93）分（P〈0．05）。按Harris功能评分标准：优36髋，良5髋，可5髋，差1髋。结论：在假体安放正确、软组织张力恢复满意基础上，后方关节囊及外旋肌群重建有助于降低后外侧入路全髋翻修术后假体脱位的发生率。     

Acetabular development after reduction in developmental dislocation of the hip

A radiologic study was conducted on 56 patients with developmental dislocation of the hip (63 hips). Fifty hips in which neither acetabular nor femoral osteotomy was performed were classified as satisfactory (Severin Groups I and II) or unsatisfactory (Severin Groups III and IV) based on radiographs when growth was completed. The sequential changes in the center edge angle and the acetabular index were compared when the patients were ages of 5, 10, and 15 years. There was a significant relationship between the center edge angle and the acetabular index when the patients were 5 years of age and at final outcome. Most (85.7%) patients with a center edge angle less than 8 degrees and an acetabular index greater than 26 degrees at 5 years of age eventually were classified as Severin Groups III and IV at skeletal maturity. These findings suggest that radiologic results at the time when growth is completed can be predicted based on the center edge angle and the acetabular index in radiologic measurements at 5 years of age. The authors recommend that if at 5 years of age the center edge angle is less than 8 degrees and the acetabular index is greater than 26 degrees, consideration be given to an osteotomy to bring these values to a more normal range to improve final outcome.     

Prevention of dislocation of total hip arthroplasty: the dual mobility cup

The concept of dual mobility cup has been developed to associate the advantages of the low friction total hip arthroplasty with those of large femoral head diameter, with the goal of preventing the dislocations. In this study, 100 primary THA and 34 revision THA with the use of dual mobility cup were analyzed clinically and radiological over a period of fellow up of ten years. It appears that the dual mobility cup is effective against dislocation. Any concerns regarding the survival of this type of prosthesis can be relativized. Literature datas indicate that mean total volumetric wear is of the same order as that reported for Charnley prosthesis with a head of 22,2 mm. However, uncertainty regarding the problem of intraprosthetic dislocation did persist.     

Acetabular development after closed reduction of developmental dislocation of the hip

The purpose of this study was to identify predictive factors that would best indicate possible future acetabular dysplasia after closed reduction of developmental dysplasia of the hip (DDH). We studied 32 hips for a mean of 13.5 years, during which time radiographs were analyzed annually. Overall results were evaluated using the modified Severin classification. Using the combined predictive factors of center-head distance discrepancy (CHDD) and sourcil orientation in patients between 4 and 5 years of age, we found that (a) remodeling of the acetabulum was possible when the CHDD was < 6% and the orientation of the sourcil was horizontal; (b) careful follow-up was needed when the CHDD was < 6% and the sourcil was upward or when the CHDD was > or = 6% and the sourcil was horizontal, (c) surgery was recommended to prevent residual acetabular dysplasia when the CHDD was > or = 6% and the sourcil was upward.     

人工全髋关节术后脱位的预防及治疗

术后髋关节脱位是人工全髋置换术(THR)后严重的并发症,如处理不善,常会引起严重的下肢功能障碍,导致关节手术失败.1994-2001年,我院共行THR手术436例,其中术后发生脱位有11例,加上外院转入5例,共16例,现报告如下.……     

Teratologic dislocation of the hip

We reviewed 27 teratologic hip dislocations in 17 patients. Four hips underwent closed reduction, 10 hips had medial adductor open reduction, 9 hips had iliofemoral open reduction, and 4 hips had iliofemoral open reduction and femoral shortening. Avascular necrosis occurred in 48%, redislocation in 19%, and subluxation in 22% of the hips. Results were best in those hips treated by anterior open reduction and femoral shortening and worst in those having closed reduction. Poor results correlated with multiple other involved joints, hypotonia, developmental delay, and poor head control.     

关于髋关节脱位的分类问题

外伤性髋关节脱位以股骨头从髋臼脱出后的位置来界定 ,在Ｎｅｌａｔｏｎ线(髂前上棘与坐骨结节连线 )之前者为前脱位 ;反之为后脱位 ;向盆腔方向穿越髋臼为中心脱位。这种分类法沿用至今〔1〕。近年有“髋关节侧方脱位”、“髋关节外侧脱位”、“髋关节前上外旋脱位”以及“创伤性髋关节前上方脱位”等报道〔2～ 5〕,将其区别于上述分类中的前后脱位。独立的侧方脱位或前上方脱位是否存在 ?对此 ,作者复习有关文献 ,并与上述作者商榷。ＤｅＰａｌｍａ依据股骨头的脱位方向将前脱位分为两个类型 ,向前内侧脱位为闭孔型 ,向前外侧脱位为耻骨型…