全髋关节置换术后脱位的原因分析及防治

目的探讨人工全髋关节置换术后脱位的原因及防治。方法回顾分析2000年3月至2008年12月9例THA术后脱位患者的术前病因、脱位原因、治疗经过及术后预防再次脱位采取的措施。结果共9例患者于住院期间发生脱位,脱位的发生率为3.1%,脱位均发生于改变体位时。髋关节术后X线片提示髋臼及股骨假体位置良好。采用闭合复位及下肢制动的方法,有3例患者在住院期间再次发生脱位,所有患者出院后至随访时未再发生脱位。结论髋关节周围软组织失衡、患肢主动或被动活动范围过大、假体安装位置不当是脱位的常见原因;脱位后大多数患者可通过麻醉下行闭合复位治疗,少数假体位置不当且稳定实验呈阳性者应考虑手术翻修;术前和术后对患者进行有关THA的康复知识教育是预防脱位的重要措施。

Causes and precautions of dislocation after total hip replacement

【Objective】 To discuss the causes and precautions of dislocation after total hip replacement(THR).【Method】 9 cases of dislocation after THR from march 2000 to Dec 2008 were retrospectively reviewed,their preoperative causes of dislocation and treatment course and prevent after the re-dislocation were analyzed.【Result】 9 cases occurred dislocation during hospitalization.Dislocation rate was 3.1%,dislocation occurred when changed the position.Postoperative hip X-Ray film prompted the acetabular and femoral prosthesis in good position.3 patients recurred during hospitalization who with the method of closed reduction and braked lower limb.All cases were followed up,and no dislocation relapsed.【Conclusion】 The common cause of dislocation after THR were related with the following: 1.imbalance of soft tissues,2.active or too large passive range of limb,3.prosthesis improperly located.Most patients can be treated with closed reduction after anesthesia.A small number of the patients who with the poor location of the prosthesis and stable test positive should consider surgery renovation.The education of rehabilitation knowledge to patients is an important measure to prevent dislocation.