人工全髋关节置换术后脱位原因分析及防治对策.docVIP

人工全髋关节置换术后脱位原因分析及防治对策 　 作者：黄炎，孔荣，方诗元，禹德万，李守民，张彪 【摘要】 [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(Plt;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(Plt;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(Pgt;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。 【关键词】 全髋关节置换术; 人工假体; 术后脱位; 原因 　　Abstract: [Objective]To analyze and prevent postoperative dislocation after total hip replacement (THR). [Method]Among 311 cases of THR treated from Jan 2001 to Dec 2006, 15 developed dislocation. These cases were retrospectively reviewed and their risk factors were investigated.[Result]Six months after THR, 15 patients (4.82%) had postoperative dislocation. Among them 11 had primary procedure and 4 had revision procedure. The dislocation rates were 4.00% and 11.11%,respectively. This difference was statistically significant (Plt;0.01). Among patients with primary procedure, the dislocation rates of bone fracture subgroup, side-lying-abduction-test-positive subgroup, posterolateral-approach subgroup and prosthesis-malposition subgroup were 6.04%, 10.29%, 4.52% and 9.93%, respectively. These differences were statistically significant (Plt;0.05) compared with the control groups. But there was no difference between the variables of gender, age and prosthesis’s diameter. No redislocation was found in 14 patients after conservation treatment. Habitual dislocation was operatively revised in one patient.[Conclusion]The causes of postoperative dislocation after THR are related with primary or revision arthroplasty, disease status, the balance of soft tissue, the operative approach and the position of prostheses, but not related with gender, age and prosthesis?s diameter. Mos