全髋置换术后脱位的原因和治疗

目的 探讨全髋关节置换术后脱位原因与治疗的关系。方法 对28例全髋置换术后脱位的病人，进行外展肌力检查和放射学测量。结果 17例侧卧外展试验阳性，8例单纯假体位置不当，11例单纯软组织不平衡，7例同时存在软组织不平衡和假体位置不当，2例假体位置正常性脱位。20例经闭合复位或一次再置换手术治疗取得成功，8例需一次以上手术治疗，5例软组织不平衡病例使用了限制性髋臼。结论 闭合复位是早期脱位的首选治疗方法，软组织不平衡的髋关节脱位，无论假体位置不当存在与否，常需多次手术治疗，手术中要考虑其机械稳定性（使用限制型髋臼假体）。

Causes and treatment of postoperative dislocation after total hip replacement

Objective To investigate the relationship between the cause and treatment of postoperative dislocation after total hip replacement (THR). Methods Radiographic measurement and physical examination of strength of abduct muscles were done in 28 patients (28 hips) with hip dislocation after THR. Results Positive test on lateral and abduction was found in 17 cases, pure cacothesis of prosthesis in 8, unbalance of soft tissue alone in 11, both cacothesis of prosthesis and unbalance of soft tissue in 7. In 2 cases the hips dislocated with the prosthesis positioning normally. Twenty patients were successfully treated either by close reduction or a revision surgery. Eight cases required more than one operation. The restrictive acetabular prosthesis was used to treat the 5 dislocated hips with unbalance of soft tissue. Conclusion Close reduction is the treatment of choice for the treatment of early dislocation after THR. A dislocated hip with unbalance of soft tissue, with or without cacothesis of the prosthesis, usually needs multiple operations for its treatment. Intraoperatively, the mechanical stability of the hip should be considered (using restrictive acetabular prosthesis).