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脱位是人工全髋关节置换术(total hip arthroplasty,THA)后常见的并发症,仅次于无菌性松动,文献报道其发生率存在很大差异,约为0.04%~ 11%.大多数脱位发生于术后3个月内,即多数为早期脱位[1].Morrey[2]报道35 000例患者术后脱位率达2.23%,Woo等[3]回顾了Mayo中心的10 500例THA的脱位率为3.2%.Demos等[4]报道初次THA术后脱位率为3.2% ~6.5%,翻修术后脱位率达7.4%~11.4%.脱位给患者造成了巨大的痛苦和心理负担,同时也给广大的骨科医生造成了极大的困扰,分析THA术后脱位的原因,并进行预防具有重要的意义.Dorr等[5]将THA术后脱位分为四类,Ⅰ类:体位性脱位:其假体位置正确,软组织平衡,脱位是由于患肢不恰当的活动引起的.Ⅱ类:软组织失衡性脱位,包括高位臼杯、股骨颈截骨过多、股骨颈过短等.Ⅲ类:假体位置不良性脱位.包括臼杯和股骨柄假体位置和方向的放置错误.Ⅳ类:同时存在软组织失衡和假体位置不良性脱位.目前认为,与THA术后脱位相关的因素包括患者因素、手术操作以及护理等. 相似文献
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全髋关节置换术后后期脱位,好发于女性及年龄相对较轻者。髋关节活动范围逐渐增大、假体位置安装不良反假体松动、神经肌肉及髋关节周围软组织因素是引起后期脱位的主要原因。 相似文献
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全髋关节置换术后脱位原因和处理 总被引:25,自引:2,他引:23
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。 相似文献
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人工全髋关节置换术后假体脱位的治疗 总被引:1,自引:0,他引:1
目的探讨人工全髋关节置换术后假体脱位的治疗方法。方法1997年7月~2004年10月,共收治人工全髋关节置换术后假体脱位23例,男9例,女14例;年龄53~79岁。行CT及X线片检查,了解假体松动情况及假体位置,并分析脱位原因。无假体松动者,麻醉下手法复位、行稳定性试验。手法复位成功且稳定者,胫骨结节牵引4~6周。手法复位失败或不稳定者,原入路切开,根据术前及术中情况,调整offset值及部分假体组件。稳定者,关节囊修补,胫骨结节牵引4~6周。仍不稳定或松动者采用翻修手术。结果23例患者,1例松动者采用全髋关节翻修;10例手法复位治疗成功;12例手法复位后不稳定或失败患者中,5例行切开复位关节囊修补,2例采用加长股骨头增加offset值,2例改用防脱位髋臼内衬,1例采用加长股骨头并调整异常髋臼内衬位置,2例仍不稳定者采用全髋关节翻修。患者均获随访1~5年,平均1.9年。均未出现再脱位。术后1年Harris评分72~94分,平均87分。结论人工全髋关节置换术后假体脱位,应根据脱位原因和术中稳定情况选择不同的治疗方法。 相似文献
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全髋关节置换术治疗先天性髋关节脱位 总被引:3,自引:0,他引:3
目的 :探讨全髋关节置换术治疗成人先天性髋关节脱位伴骨性关节炎的经验。方法 :从 1996年 9月~2 0 0 3年 2月 ,对 14例 (2 0髋 )成人先天性髋关节脱位伴骨性关节炎患者 ,进行了全髋关节置换。其中双侧 10例 ,单侧 4例。病人全是女性 ,平均年龄 45岁 (3 5~ 67岁 )。双侧全髋置换 6例 ,单侧 8例。结果 :术后伤口均一期愈合 ,随访 6个月~ 6年 ,平均 4年 8个月 ;平均Harris评分由术前的 3 2 43分恢复到术后 1年的 90 15分。截止目前无 1例翻修。术后 6个月 ,患者均能下地行走 ,生活自理且恢复日常工作。结论 :全髋关节置换术是治疗成人先天性髋关节脱位伴骨性关节炎的有效方法 ,但手术难度较大。对于此类病人 ,充分理解全髋置换的复杂性和细致周密的治疗方案是成功的关键。 相似文献
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浅谈全髋关节置换术后早期脱位(附47例全髋置换术3例脱位报告) 总被引:2,自引:0,他引:2
邵翔绪 《中国矫形外科杂志》1999,6(6):413-415
目的:回顾性研究21年来行全髋关节置换术的早期脱位率与相关因素。方法:45例47髋行全髋关节置换术病例,年龄26~87岁,术前诊断37例为股骨头缺血性坏死,占78%;2例为先天性髋关节脱位;8例为股骨颈骨折。结果:术后早期脱位2例3髋,脱位率为63%。1例新鲜股骨颈骨折,1例陈旧股骨颈骨折行THA术后第1d即发生脱位。新鲜股骨颈骨折第3d行翻修术,术中见股骨侧假体自前倾位变为后倾,纠正位置后治愈。陈旧股骨颈骨折经闭合复位,牵引后仍反复脱位,3月后行翻修术,术后第8d又脱位,再次经闭合复位,牵引治愈。结论:术后早期脱位与术者经验,术前设计,假体部件的安装,尤其是髋臼假体及髋臼对人工股骨头的覆盖以及外展肌的力量有关。 相似文献
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全髋关节置换术后脱位的研究进展 总被引:5,自引:1,他引:5
脱位是全髋关节置换术(THA)后常见的并发症,仅次于无菌性松动,它是引起翻修术、全髋关节置换失败的第二大原因[1].一旦发生,可能需要延长住院时间、康复时间.本文就全髋关节置换术后脱位的危险因素及治疗作一综述. 相似文献
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Late dislocation after total hip arthroplasty 总被引:7,自引:0,他引:7
von Knoch M Berry DJ Harmsen WS Morrey BF 《The Journal of bone and joint surgery. American volume》2002,(11):1949-1953
BACKGROUND: Some patients have a dislocation for the first time many years after a total hip arthroplasty, but little is known about the risk factors and outcomes associated with late dislocation. The purposes of this study were (1) to determine the prevalence of late dislocation after total hip arthroplasty, (2) to characterize demographic and other factors associated with such late dislocations, and (3) to report the outcomes of such late dislocations. METHODS: Between 1969 and 1995, 19,680 primary total hip arthroplasties were performed in 15,964 patients at our institution. According to a prospective surveillance protocol, the patients were followed routinely at regular intervals and were specifically queried at each time-point about whether (and, if so, when) the hip had dislocated. First dislocations that occurred five years or more after the operation were defined as late dislocations. RESULTS: Five hundred and thirteen (2.6%) of the 19,680 hips dislocated. Of the 513 hips, 165 (0.8% of the entire cohort; 32% of the dislocated hips) first dislocated five or more years after the primary arthroplasty. The median time until the occurrence of these late dislocations was 11.3 years (range, five to 24.9 years) after the operation. Late dislocation was more frequent than early dislocation in women (p = 0.03), and late dislocation was associated with a younger age at the time of the primary total hip arthroplasty (median, sixty-three years) than was early dislocation (median, sixty-seven years) (p = 0.02). Clinical factors associated with late dislocation included previous subluxations without dislocation in twenty patients, a substantial episode of trauma in eleven patients, and onset of marked cognitive or motor neurologic impairment in eleven patients. Radiographically, the late dislocation occurred in association with polyethylene wear of >2 mm in eighteen hips, with implant loosening with migration or a change in position in eight, and with initial malposition of the acetabular implant (anteversion of <0 degrees or >30 degrees or abduction of >55 degrees) in thirty. Late dislocation recurred in ninety (55%) of the 165 hips and was treated with a reoperation in fifty-five hips (33% of the hips with late dislocation; 61% of the hips with recurrent dislocation). CONCLUSIONS: Late dislocation is more common than was previously thought. Several separate processes, some distinct from those associated with early dislocation, can lead to late dislocation. Late dislocation can occur in association with a long-standing problem with the prosthesis that manifests late (such as malposition of the implant or recurrent subluxation), it can occur in association with a new problem (such as neurologic decline, an episode of trauma, or polyethylene wear), or it can occur in association with any combination of these factors. The likelihood of the first late dislocation recurring is high. 相似文献
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N. Levi P. Gebuhr 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2001,11(1):47-49
Background The average incidence of dislocation after total hip arthroplasty is approximately 3%. However, the choice of surgical approach can affect the rate of postoperative dislocation. A 5.8% dislocation rate has previously been reported when a posterolateral approach was used compaired with 2.3% when an anterolateral approach was used. The aim of this study was therefore to assess the dislocation rate after total hip replacement with the posterolateral approach.Methods: Between January 1992 and December 1998, a posterolateral approach was used for 427 consecutive primary total hip replacements. There were 291 women and 136 men. The average age of the women was 71 years (range 40–91 years) and the average age of the men was 65 years (range 34–86 years). The one-year dislocation rate was recorded.Results: A total of 24 hip replacements (6 in men and 18 in women) dislocated. The one-year dislocation rate was 6/136 = 4.4% for men and 18/291 = 6.2% for women. The overall one-year dislocation rate was therefore 24/427 = 5.6%. The average delay between the operation and the dislocation was 7 weeks (range 1 day to 1 year).Conclusions Our results seem to confirm a high postoperative dislocation rate when the posterolateral approach is used. Most dislocations occured within the first 3 months after the surgery. An unexpected annual variation in the dislocation rate was found. No explanations was found for this variation. 相似文献
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N.J. Talbot MA FRCS J.H.M. Brown MRCS N.J. Treble MCh Orth FRCS 《The Journal of arthroplasty》2002,17(8):1006
We studied prospectively 499 cases of primary total hip arthroplasty done through an anterolateral approach to establish the early dislocation rate when restrictions on postoperative mobilization were not imposed. There were 3 early dislocations (within 6 weeks of surgery). All were reduced closed, and every patient subsequently achieved a stable hip without further intervention. Our results suggest that a low early dislocation rate can be achieved using an anterolateral approach without the need to restrict patients' postoperative mobilization. It may not be appropriate, however, to remove these restrictions when using other surgical approaches to the hip. 相似文献
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H Z Herold 《Clinical orthopaedics and related research》1989,(242):195-200
Thirty-two total hip arthroplasties (THAs) were performed on 26 severely incapacitated patients with congenital dislocation of the hip. The arthroplasty technique varied with the problems encountered, but the cup was always placed in the true acetabulum. In 19 cases, femoral head autografts were transplanted. The overall results were satisfactory. Roentgenologic evaluation of the bone grafts showed no nonunion or secondary displacement. Nineteen previously invalid patients now lead normal lives. Five patients are minimally incapacitated and only two were unimproved by the operation. THA with autogeneic grafts to deepen the acetabulum is recommended whenever a congenital dislocation of the hip in an adult is associated with severe pain. 相似文献
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《The Journal of arthroplasty》1998,13(1):17-21
One hundred sixty-one dislocations after cemented total hip arthroplasty, with a mean follow-up period of 8 years after dislocation, were reviewed with the aim of establishing the prognosis. There were 84% single and 16% recurrent dislocations. Closed reduction was successful in 81% of cases. Thirty-seven percent of dislocations were early (within 5 weeks), 36% occurred in patients who had had previous surgery, and in 47% there was nonunion of the trochanter. There was a two-way interaction between these factors, and all factors were significant for recurrent dislocation. Twenty-six (16%) recurrent dislocations required surgery. The most common causes of recurrent dislocation demonstrated at operation were component malposition (58%) and failure of the abductor mechanism (42%). In total, 96% of cases were successfully treated. 相似文献
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Study of hip joint dislocation after total hip arthroplasty 总被引:2,自引:0,他引:2
Masaoka T Yamamoto K Shishido T Katori Y Mizoue T Shirasu H Nunoda D 《International orthopaedics》2006,30(1):26-30
The present study was undertaken to identify the factors responsible for hip joint dislocation after total hip arthroplasty, laying emphasis on analysis of the background variables of the patients. Of the 317 hips included in the study, ten (3.2%) dislocated. Only the anteversion angle of the cup differed significantly between the dislocation group and the dislocation-free group. The safe zone of the anteversion angle seems to be between 20 and 30 degrees. but it is also essential to set the antetorsion angle of the stem to match the shape of individual bones to create a more stable hip joint. This safe zone may be expanded by the additive effect of antetorsion angle of the stem. 相似文献
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全髋关节置换术后股骨假体周围骨折的发生率近年来不断增加,已成为继假体松动和复发性脱位之后导致髋关节翻修的第3位最常见原因。股骨假体周围骨折治疗难度大,手术失败率高,有一定致死率。认识并避免导致股骨假体周围骨折的危险因素,正确掌握各类型骨折的治疗原则,准确判断股骨假体的稳定性,并选择适当的内固定或翻修方法,是获得可靠治疗疗效的保证。 相似文献
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非骨水泥型全髋关节置换治疗成人高位发育性髋脱位 总被引:1,自引:0,他引:1
目的:分析和总结成人高位发育性髋脱位患者的非骨水泥型全髋关节置换手术方法及疗效。方法:对1999年5月~2002年7月接受Zweymuller非骨水泥型全髋关节置换术的9例(11髋)成人高位发育性髋脱位患者进行随访。男1例,女8例,平均年龄29.4岁,均为Hartofilakidis Ⅲ型。临床症状主要为患髋疼痛、不稳定和跛行。术前Harris评分平均为40.2分。双下肢长度差异平均4.1cm,脱位高度平均4.8cm。术中臼杯均安装于真臼处,臼杯骨量覆盖80%以上。脱位高度5cm以上4髋,采用股骨小转子下截骨,余7髋经单纯软组织松解后复位。结果:平均随访18.2个月。临床症状基本消失,双下肢长度差异平均1.1cm。1例术中股神经不全损伤,术后4个月恢复。Harris评分平均90分。所有患者最后随访时对治疗结果满意。结论非骨水泥型全髋关节置换对成人高位发育性髋脱位的治疗是一种较理想的方法,能很大程度地改善患者的生活质量。脱位高度小于5cm者,经软组织松解后能完全下拉复位,不会造成股神经及坐骨神经永久性麻痹。手术操作相对简单,即使发生松动也便于翻修。 相似文献