van der Grinten M, Verhaar J A N
Erasmus Medisch Centrum, afd. Orthopedie, Postbus 2040, 3000 CA Rotterdam.
Ned Tijdschr Geneeskd. 2003 Feb 15;147(7):286-90.
Primary hip prostheses dislocate in 0.4 to 8.7% of the cases. Revision hip prostheses dislocate in 5 to 20% of the cases. High age, female sex, co-morbidity and alcoholism increase the risk of dislocation. The surgical approach of the hip and the experience of the surgeon are important factors in the operation technique. The anterior approach causes the least dislocations, but a disadvantage of this approach is that patients are more likely to walk with a limp afterwards. The selected implant also influences the dislocation risk. The smaller the head, the narrower the neck must be. Furthermore, the femur must not come to be too close to the pelvis. If necessary, a cup can be used with a raised anterior edge. Treatment of a primary dislocation is usually conservative and is based on providing the patient with guidelines. An abduction brace can be prescribed if a patient is not able or willing to comply with these rules. If dislocation is a recurring problem, revision of the prosthesis is often the only solution.
初次髋关节置换术后假体脱位的发生率为0.4%至8.7%。翻修髋关节置换术后假体脱位的发生率为5%至20%。高龄、女性、合并症和酗酒会增加脱位风险。髋关节的手术入路和外科医生的经验是手术技术中的重要因素。前路手术导致的脱位最少，但这种手术方式的一个缺点是患者术后更易出现跛行。所选的植入物也会影响脱位风险。股骨头越小，股骨颈必须越窄。此外，股骨不能过于靠近骨盆。如有必要，可使用前缘抬高的髋臼杯。初次脱位的治疗通常是保守的，基于为患者提供指导原则。如果患者不能或不愿意遵守这些规则，可开具外展支具。如果脱位是一个反复出现的问题，假体翻修往往是唯一的解决办法。
