Mahoney Craig R, Pellicci Paul M
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
Instr Course Lect. 2003;52:247-55.
Dislocation in primary total hip arthroplasty is common and problematic and is attributable to several factors, including previous hip surgery, neuromuscular disorders, cerebral dysfunction, psychosis, alcoholism, and female gender. Factors under the control of the surgeon include component orientation and restoration of soft-tissue tension. Prosthetic factors lowering the risk of dislocation include increasing the size of the prosthetic femoral head, keeping femoral neck circumference to a minimum, and optimizing the geometry of the acetabular component. Postoperatively, patients should be expected to comply with standard hip precautions. Treatment is with immediate closed reduction. Multiple dislocations can be treated by advancing the trochanter in the presence of inadequate soft-tissue tension, revision arthroplasty in the presence of malpositioned components, or the use of a constrained cup when intraoperative instability persists. Because the risk of redislocation is much higher than that for first-time dislocation, prevention is critical. An enhanced repair technique can be used to reconstruct the posterior soft-tissue sleeve during the posterior surgical approach. This technique has been successful in lowering the dislocation rate from 4% to 0% in a series of 395 consecutive patients.
初次全髋关节置换术中脱位很常见且成问题，可归因于多种因素，包括既往髋关节手术、神经肌肉疾病、脑功能障碍、精神病、酗酒以及女性性别。外科医生可控的因素包括假体的方向和软组织张力的恢复。降低脱位风险的假体因素包括增加假体股骨头的尺寸、将股骨颈周长保持在最小值以及优化髋臼假体的几何形状。术后，应期望患者遵守标准的髋关节预防措施。治疗方法是立即进行闭合复位。对于多次脱位，若软组织张力不足，可通过推进转子进行治疗；若假体位置不当，可进行翻修置换术；若术中持续存在不稳定情况，可使用限制性髋臼杯。由于再次脱位的风险远高于首次脱位，预防至关重要。在后方手术入路过程中，可采用改良修复技术重建后方软组织袖。在一系列连续395例患者中，该技术已成功将脱位率从4%降至0%。
