人工髋关节置换术后假体脱位原因分析与处理

目的探讨人工髋关节置换术(artificial hip replacement,AHR)后假体脱位的原因及处理措施。方法对2000年1月至2010年7月本院和外院收治的17例AHR术后假体脱位患者的术前病因和假体脱位原因进行回顾性分析,并对其进行手法复位和手术治疗。结果术后经4个月～10年随访,17例患者中16例未发生再次脱位,1例于3个月内多次脱位的患者经手术治疗后未再出现脱位。结论假体位置不良、髋关节周围软组织失衡、术者经验不足以及病人因素是假体脱位的常见原因;提高手术水平、采取规范的手术技术、实施术后功能康复和健康教育是预防脱位的重要措施。     

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.……     

全髋关节置换术后髋关节脱位的原因探讨及防治对策

目的 探讨全髋关节置换术（total hip arthroplasty,THA）后髋关节脱位的易发因素、治疗方法及预防措施。方法 回顾性分析2002年4月-2005年9月5例THA术后髋关节脱位患者的临床资料。行手法复位、外展皮牵引术4例,因手法复位后脱位复发而再次手术翻修1例。结果 术后经1-3年随访,3例未再发生脱位;1例高龄患者因患侧臀中肌无力,反复出现脱位而放弃治疗;1例患者牵引治疗出院后再次出现脱位,入院行翻修手术,术后随访3年未再出现脱位。结论 体位因素、假体安装位置不当及髋关节周围软组织失衡是引起术后髋关节脱位的主要原因。脱位后大多数患者可通过保守治疗纠正,但对反复脱位、假体位置严重不当或松动患者应考虑手术翻修。     

人工全髋关节置换术后脱位的原因分析和防治对策

[目的]探讨人工全髋关节置换术后脱位的原因分析和防治对策.[方法]本科自2001年1月～2006年12月行全髋置换术311例,对术后脱位15例患者进行回顾性分析,评价术后脱位的危险因素及防治对策.[结果]所有病例中术后6个月发生脱位15例(脱位率4.82%),首次全髋置换术后脱位11例,脱位率4.00%,而全髋翻修术后脱位4例,翻修手术脱位率11.11%,两者有显著差异(P＜0.01).首次全髋置换手术患者中,骨折组、侧卧外展试验阳性组、后外侧入路组、髋臼假体置于安全区外组,患者术后脱位率分别为6.04%、10.29%、4.52%、9.93%,均明显高于对照组(P＜0.05),而不同性别、年龄以及使用不同直径股骨头的患者中术后脱位率无明显差异(P＞0.05).15例脱位中14例经保守治疗后未再发生脱位.1例患者发生习惯性脱位,行全髋翻修后未再发生脱位.[结论]全髋关节置换术后脱位与是否翻修,术前疾病状态,组织的肌力平衡,手术入路,假体位置的安放等因素有关,与患者性别、年龄以及假体设计无关.大多数脱位患者通过保守治疗未再发生脱位.通过改进手术方式,正确安放假体位置,及在医师指导下康复训练等会降低人工全髋关节置换术后脱位率.     

全髋关节置换术后脱位原因和处理

目的：探讨人工全髋关节置换术（THA）后发生脱位的原因和处理。方法：随访研究36例（36髋）THA后发生脱位的原因、处理及结果,分析其外展肌力和测量骨盆正位片上有关参数。结果：36例脱位中,外展肌乏力20例;髋臼假体位置不良10例;其他综合因素6例。其中17例采用手法复位、髋人字石膏固定获得成功,19例手法失败或再脱位故行切开复位。结论：THA术后脱位由多种因素引起,与手术入路、假体位置、软组织张力等有关;闭合复位或开放复位后髋人字石膏固定,大多数早期能获得成功。软组织张力低,特别是外展肌力乏力是THA脱位最重要原因。     

脑血管意外患者髋关节置换术后并发症的原因及预防

目的探讨脑血管意外患者行人工髋关节置换术后产生并发症的原因及防治措施.方法采用人工髋关节置换术治疗脑血管意外患者12例, 分析其术后出现并发症的原因,并提出预防措施.结果平均随访2年3个月, 近期无痛或轻微痛关节10个,关节功能明显改善9个, 术后发生并发症5例,其中关节脱位4例(后发生异位骨化1例、髋痛2例),假体松动1例. 结论脑血管意外患者因髋部疾病致功能障碍而行髋关节置换手术者术后关节脱位发生率较高;术后不宜过早负重下地活动;加强康复训练是手术成功的重要因素之一.     

人工全髋关节置换术后早期假体脱位的原因分析及防治措施

目的探讨人工全髋关节置换术后早期假体脱位的原因分析及防治措施。方法对首次行人工全髋关节置换术98例,发生术后髋关节脱位5例,其中3例为后脱位,1例为前脱位,股骨假体下沉脱位1例。结果 5例脱位患者中3例麻醉后手法整复成功;1例前脱位以后脱位手法整复未成功,术中证实为髋臼前倾角过大;1例为股骨假体过小术后下沉,术中更换大一号股骨假体。结论假体位置异常是人工全髋关节置换术后早期假体脱位的主要原因;规范医生操作及假体放置、正确指导患者术后功能锻炼,能有效预防早期脱位的发生。     

人工髋关节置换术失败原因分析

目的 对人工髋关节置换术后失败的病例进行分析。总结经验，提高人工髋关节置换术的长期疗效。方法 １９９６年１１月～１９９９年４月共进行人工髋关节翻修手术３５例（３６髋），根据前次手术失败的原因进行分组并分析。结果 根据病例统计，在同一失败病例中，失败的原因往往不止一个，最常见的原因是假体松动、假体周围骨溶解，共２４例次，其次为人工股骨头引起髋臼磨损７例次，假体置入位置不良６例次，人工髋关节脱位３例次，术后感染３例次，假体股骨西柄断裂２例次。结论 人工髋关节置换术作为髋关节重建的一种有效的治疗方法而得到广泛的应用。其长期可靠的疗效与严格掌握手术指征，假体的适当选择和手术中正确操作有关。     

人工髋关节置换术后早期脱位原因探讨及防治

目的探讨人工髋关节置换术后髋关节早期脱位的原因和防治措施。方法对本院1996年3月至2005年12月人工髋关节置换术后髋关节早期脱位作回顾性研究，X线评价术后髋关节脱位情况。结果本组63例。术后3～10d内有3例发生人工全髋关节脱位，发生率为4．8％。术后髋关节活动幅度过大，大粗隆骨折致假体柄松动、髋臼假体位置不良各1例。第1例在麻醉下手法复位，第2例需手术复位固定骨折和假体，第3例需重置髋臼假体位置。结论术后髋关节活动幅度过大，大粗隆骨折致假体柄松动、髋臼假体位置不良是人工髋关节置换术后发生髋关节早期脱位的常见原因，正确处理有利于预防髋关节脱位的并发症。     

全髋人工关节置换术后脱位的原因分析及防治

目的　分析全髋人工关节置换（ＴＨＲ） 术后脱位的原因并探讨防治措施。　方法　１９７８～１９９８ 年行ＴＨＲ的患者８５０ 例,其中发生脱位者１５ 例,脱位率约为１－７％ ;其中行２ 次以上手术者１１例,初次手术４ 例。对发生脱位的１５ 例患者的手术情况和脱位原因进行分析。　结果　１５ 例患者中,髋部行２ 次以上手术者１１ 例,均采用后外侧入路,发生后脱位;２ 例采用外侧入路,发生前脱位;２例与假体设计有关,发生髋臼假体金属杯与聚乙烯帽间的脱离。１５ 例患者除１ 例采用闭合复位成功外,其余均切开复位,对假体位置不佳的患者行翻修术,对外展肌肌力弱的患者进行加强修补,或处理大粗隆,以增加外展肌肌力。经随访,均未再发生脱位。　结论　假体置入位置欠佳、两侧软组织不平衡（ 尤其是外展肌的破坏） 是造成ＴＨＲ术后脱位的主要原因;术前仔细评价患者骨盆发育情况,并注意一些骨性标记的变异,术中正确安装假体,仔细清理髋臼周围的骨赘与骨水泥以及注意髋周围软组织的修复,关闭伤口前认真检查手术髋的稳定性,是预防ＨＴＲ术后脱位的有效措施     

H／G非骨水泥人工全髋关节置换术后髋臼侧的X线观察

目的：观察Ｈ／Ｇ非骨水泥人工全髋关节置换术后髋臼假体周围的骨反应。方法：根据Ａｍｓｔｕｔｚ的分区方法对２５例２８个Ｈ／Ｇ人工全髋关节进行髋臼侧Ｘ线随访观察。随访时间３６～７６个月，平均４８个月。结果：髋臼侧出现各种骨反应２３个关节，占关节总数的８２．１％。其中髋臼假体周围成骨２２个关节，占关节总数７８．５％；透亮带出现４个关节，占关节总数的１４．３％；骨硬化２个关节，占关节总数的７．１％；骨吸收２个关节，占关节总数的７．１％；无髋臼松动病例。发生时间以９～１２个月为主，发生部位以１～３区为多见。结论：假体周围成骨是骨小梁长入髋臼表面微孔区域，受力后逐渐增粗变大的现象，对长期稳定假体十分重要。但对于吸收类骨反应和透亮带的出现，作者通过改良手术操作，以期避免或减少发生。     

Usefulness of Arthroscopic Treatment of Painful Hip after Acetabular Fracture or Hip Dislocation

Background

Painful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology. However, there is limited literature discussing the use of arthroscopy for the treatment of painful hip. The purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma.

Methods

From July 2003 to February 2013, we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years. The degree of osteoarthritis based on the Tonnis classification pre- and postoperatively at final follow-up was determined. Clinical outcomes were evaluated using visual analogue scale for pain (VAS) and modified Harris hip score (MHHS), and range of motion (ROM) of the hip pre- and postoperatively at final follow-up.

Results

There were nine male and four female patients with a mean age at surgery of 28 years (range, 20 to 50 years). The mean follow-up period of the patients was 59.8 months (range, 24 to 115 months), and the mean interval between initial trauma and arthroscopic treatment was 40.8 months (range, 1 to 144 months). At the final follow-up, VAS and MHHS improved significantly from 6.3 and 53.4 to 3.0 and 88.3, respectively (p = 0.002 and p < 0.001, respectively). However, there were no significant differences in hip flexion, abduction, adduction, external rotation, and internal rotation as minor improvements from 113.1°, 38.5°, 28.5°, 36.5°, and 22.7° to 118.5°, 39.0°, 29.2°, 38.9°, and 26.5° were observed, respectively (p = 0.070, p = 0.414, p = 0.317, p = 0.084, and p = 0.136, respectively). None of the patients exhibited progression of osteoarthritis of the hip at the final follow-up.

Conclusions

Arthroscopic treatment after acetabular fracture or hip dislocation is effective and delays the progression of traumatic osteoarthritis.     

Arthroscopic Treatment of Acetabular Rim Fracture after Traumatic Posterior Hip Dislocation: A Case Series Study

ObjectiveTo investigate the clinical and radiographic short‐term results of arthroscopic treatment for posterior labrum tears with an attached bony fragment after traumatic posterior hip dislocation.MethodsBetween July 2014 and May 2019, a consecutive series of nine patients diagnosed with a posterior labrum tear with an attached bony fragment after traumatic posterior hip dislocation were treated by hip arthroscopic techniques. The patients had been injured in traffic accidents (n = 6) or high falls (n = 3). All patients were provided primary treatment at the emergency department of our institution, and then were transferred to our department for arthroscopy. Demographic data (e.g. gender, age, etc), intraoperative findings, the preoperative and postoperative multiple clinical scores and radiological results were subsequently assessed. Visual analogue scale for pain (VAS) and modified Harris hip scores (mHHSs) were measured and compared before surgery, and at the last follow‐up.ResultsA total of nine patients were enrolled, all of them were male, with a mean age at surgery of 32.2 ± 5.6 years (range, 22–65 years). The patients were followed‐up for an average of 26.5 ± 4.1 (range, 24 to 50 years). During the arthroscopic surgery, all patients had labral tears with posterior acetabular rim fracture. All patients had loose osteochondral fragments. Five had partial or complete tears of ligamentum teres. Two patients had osteochondral damage. Two had capsular rupture. Postoperative X‐ray films and three dimension computed tomography (3D‐CT) showed satisfactory reduction of posterior acetabular wall fractures. The mHHS before surgery and at 1 year and 2 years after surgery were 51.8 ± 4.3, 81.8 ± 2.0 and 87.5 ± 1.9 respectively; VAS scores were 5.6 ± 0.5, 1.3 ± 0.3 and 0.7 ± 0.3 respectively. As compared with the condition before surgery, there was a significant improvement in the mHHS and VAS scores at 1 year and 2 years after surgery (P < 0.01). There was no significant improvement in the mHHS and VAS scores between 1 year and 2 years after surgery (P < 0.05). At the final follow‐up, all patients had regained full range of motion (ROM) and were satisfied with the results. None of the patients showed signs of heterotopic ossification, avascular necrosis or progression of osteoarthritis of the hip joint.ConclusionTraumatic dislocation is accompanied by a variety of intra‐articular hip joint pathologies. Managing posterior acetabular rim fracture after traumatic posterior hip dislocation using arthroscopic reduction and fixation with anchors is a safe and minimally invasive option and delays the progression of traumatic osteoarthritis.     

人工股骨头置换与全髋关节置换术治疗股骨颈骨折

目的了解、评价人工股骨头置换与全髋关节置换术治疗股骨颈骨折的价值和选择。方法从１９９０年１月～１９９６年１２月住院治疗的股骨颈骨折病例中,选择年龄、性别、随访时间均相仿的人工股骨头置换术患者５４例,全髋置换术患者６０例,进行回顾性分析。结果发现两种术式的住院时间相仿,早期并发症均较低;人工股骨头置换组的中、远期并发症、再手术率较高,全髋置换组手术创伤。假体费用较大,随访功能优良率较高。结论全髋置换术适合于５５岁以上、有移位的头下型患者,人工股骨头置换术适合高龄或全身情况较差者。     

Factors Associated with Early Loosening of Cemented Total Hip Prostheses

Patient data and radiograms from a series of 237 consecutive total hip replacements were evaluated by means of a computer programme in an attempt to study factors correlated with early loosening. We found that the loosening rate was significantly influenced by several factors. the CAD-prosthesis (Computer Assisted Design, Howmedica) was found to be superior to the Charnley-Muller-prosthesis. the viscosity of the cement seemed to be an important factor in that low viscosity was positively correlated to loosening whereas high viscosity showed a negative correlation. Several technical details in the performance of the operations as well as loosening correlated with the surgeon. Males who preoperatively had fairly unrestricted physical activity and high body weight were more prone to early loosening. No correlation was found with the diagnosis, previous hip surgery, age, osteoporosis or cortisone treatment preoperatively. We wish to underline the importance of a thorough technique and suggest that total hip replacement should be performed by specialized surgeons.     

新型国产髋关节假体用于人工髋关节置换的随机对照研究

目的 通过随机对照临床试验,评价一种新型国产髋关节假体用于人工全髋关节置换术(total hip arthroplasty,THA)的临床疗效和安全性.方法 本研究采用多中心、随机、单盲、阳性平行对照设计,在全国5家医院共招募72例受试者,分别纳入试验组和对照组,各36例.试验组使用新型国产髋关节假体,对照组使用成熟的...     

高龄患者生物型全髋置换术的早期疗效与并发症分析

目的 总结分析高龄患者(≥75岁)应用生物型全髋置换术治疗的早期疗效与并发症.方法 2003年2月～2007年8月共行28例(28髋)高龄患者生物型全髋置换术.术前诊断:骨性关节炎16例,股骨头坏死7例,陈旧性股骨颈骨折3例,新鲜髋臼骨折合并股骨颈骨折1例.陈旧性髋臼骨折1例.每次随访时行临床疗效评估、X线检查;记录术中、术后并发症.结果 患者均获得随访,平均2.5年(1～5.5年).随访期间无一例死亡.临床疗效:术前Harris评分平均42分(8～54分),最后一次随访时平均87分(66～97分),其中优9例,良16例,可2例,差1例,优良率为89.3%.术前5例(17.9%)中度疼痛、19例(67.9%)重度疼痛、4例(14.3%)极重度疼痛.最后一次随访时25例(89.3%)疼痛消失、2例(7.1%)微痛、1例(3.6%)轻度疼痛.X线表现:髋臼假体外展角为43.5°(38～56°),前倾角13.5°(4～20°),最终随访时无假体移位或松动现象;股骨侧最终随访时可见假体周围骨性稳定27髋,纤维稳定1髋;假体下沉<2mm者3髋,其余均无假体下沉.并发症:术中无血管、神经损伤;术后脱位3例,脱位率为10.7%,伤口浅表感染1例,异位骨化2例.结论 生物型全髋置换术治疗高龄患者早期能取得满意的临床疗效和X线表现,但是术后脱位等并发症不容忽视,应积极预防并发症的发生.     

Assessment of Acetabular Component Anteversion after Total Hip Arthroplasty: Comparison of Anteroposterior and Cross-Table Lateral Radiographs with Computed Tomography Scans

BackgroundSeveral methods of measurement of anteversion of acetabular components after total hip arthroplasty (THA) have been described in the literature using plain radiographs or computed tomography (CT) scans. None of these have proved to be the gold standard. We aimed to study the correlation between the CT and radiographic methods of calculation of acetabulum anteversion.MethodsCT scans of the pelvis, anteroposterior (AP) and cross-table lateral (CL) radiographs were obtained in 60 patients who underwent THA two weeks after surgery. Anteversion was measured using Widmer method and Liaw method on AP radiographs, and the ischiolateral method on CL radiographs. Anteversion measured on the CT scan was taken as the reference anteversion and the above measurements were analysed for correlation with the measurements on CT scan. Intraclass correlation coefficients (ICCs) were calculated for both intra- and interobserver reliability.ResultsMean acetabular version on CL radiographs was 53.1 ± 10.7. Mean version on AP radiographs by Widmer method was 21.4 ± 3.6 and by Liaw method was 20.3 ± 4.8. Mean version on CT scans was 26.02 ± 6.8. There was a good correlation between the acetabular version on CT scans with the version on AP radiographs by Widmer method (r = 0.78, p < 0.001) and Liaw method (r = 0.87, p < 0.001). Good correlation was seen between the acetabular version on CL radiographs and CT scans (r = 0.91, p < 0.001). Also, a good correlation was observed between the acetabular version measurements on CL radiographs and AP radiographs by Widmer method (r = 0.81, p < 0.001) or Liaw method (r = 0.70, p < 0.001). Excellent inter- and intraobserver reliability were seen for all the measurements.ConclusionsCalculation of acetabular component version on AP views as well as CL views of plain radiographs showed a strong correlation with the version measurements on CT scans. Good correlations were observed between different techniques of measurement on radiographs. Therefore, all these measurements can be valid methods for assessment of anteversion.     

Factors Associated with Calcar Resorption in Cemented Total Hip Prostheses

Patient data and radiograms from a series of 237 total hip replacements were evaluated by means of a computer program. Middle-aged patients and those without other dysfunctions of the lower extremities than the primary hip disease were prone to develop calcar resorption. Patients who did not use supportive aids preoperatively and subjects doing well without aids postoperatively were more frequently represented in the group with calcar resorption. The CAD-prosthesis (Computer Assisted Design, Howmedica), was positively correlated to resorption at calcar at 6 months postoperatively compared to the Charnley-Muller prosthesis. A negative correlation to valgus oriented femoral components was noted. Vertical placement of the acetabular cup, large cups and a long distance between the femur and the pelvis was noted to occur more often in the group with calcar resorption. Mechanical factors are concluded to be predominant in early calcar resorption and are suggested to be of clinical importance for the long term results.