全髋关节置换术后早期脱位原因分析及预防

目的：探讨全髋关节置换术后6个月内脱位原因及有效预防方法。方法：对320例全髋关节置换术患者，进行侧卧外展试验和放射学测量，分析术后早期脱位原因。结果：在320例全髋关节置换术后6个月共发生脱位15例，脱位率4．7％，其中翻修手术26例，发生脱位3例，脱位率11．5％，两者有显著差异（P〈0．01）。侧卧外展试验阳性患者132例，脱位8例，脱位率6．06％，试验阴性患者188例，脱位7例，脱位率3．72％，两者有统计学差异（P〈0．05）。测量术后X片臼杯安放位置在安全区内共285例，发生脱位7例，脱位率2．8％，在安全区外共35例，发生脱位8例，脱位率22．9％，两者有显著差异（P〈0．01）。使用具有防脱位高边的髋臼假体患者240例，发生脱位者8例，脱位率3．33％，使用普通髋臼假体患者80例，发生脱位7例，脱位率8．75％，两者有统计学差异（P〈0．05）。经后外侧入路手术患者160例，发生脱位9例，脱位率5．62％，经后外侧入路并保留修复关节囊患者160例，发生脱位6例，脱位率3．75％，两者有统计学差异（P〈0．05）。不同年龄、体重、性别的患者术后脱位率无显著差异。结论：全髋关节置换术后脱位与假体的放置位置、组织肌力平衡、手术是否保留修复关节囊、假体设计和是否翻修等因素有关，而与年龄、性别、体重等因素无关。精确假体置入、术后完善的护理可有效降低脱位发生率。

Postoperative dislocation in early phase after total hip replacement: Causes and prevention

Objective:To investigate the causes of postoperative dislocation in early phase after total hip replacement and preventive countermeasures.Methods:Radiographic measurement was done in 320 patients who had received total hip replacement to analyze the anteversion and abduction angles of acetabulum cup.Side lying abduction tests were also performed in these patients.Results:15 cases of dislocation occurred in these 320 cases 6 months later.The dislocation rate of revision arthroplasties 11.5%(3/26) was signif...