Kerschbaumer F, Kerschbaumer G, Deghani F
Klinik Rotes Kreuz, Frankfurt, Deutschland.
Orthopade. 2007 Oct;36(10):928-32, 934. doi: 10.1007/s00132-007-1144-x.
The use of the dorsal approach to the hip joint for insertion of an endoprosthesis is associated with a dislocation rate of 1-7%, which is higher than comparable operations using an anterolateral approach. In recent years an enhanced dorsal capsular reconstruction technique has been recommended with increasing frequency. This has reduced the likelihood of dislocation to 0-3%. Controlled studies comparing the dorsal approaches with and without soft tissue reconstruction have documented significantly better results after soft tissue reconstruction, with a probability of 0-3% for dislocation. In order to understand the dorsal instability of the hip joint following implantation of an endoprosthesis, we describe the pathophysiology and the possible reasons for dislocation. Many factors, such as cup position, length of the neck of the femoral implant, diameter of the implant head, the condition of the dorsal soft tissues and the patient's general condition, influence the outcome of the operation and the frequency of dislocation. Possible ways for preventing posterior dislocation are described with reference to both surgical technique and patient selection. The current range of surgical treatment options for recurrent dislocation are presented: modular cups, dual-head cups, constrained cups, high offset femoral neck and soft tissue interventions.
采用髋关节后路入路植入假体时，脱位率为1%-7%，高于采用前外侧入路的类似手术。近年来，一种改良的背侧关节囊重建技术的推荐频率越来越高。这已将脱位可能性降低至0%-3%。比较有无软组织重建的后路入路的对照研究表明，软组织重建后效果明显更好，脱位概率为0%-3%。为了解假体植入后髋关节的后方不稳定情况，我们描述了其病理生理学及脱位的可能原因。许多因素，如髋臼位置、股骨假体颈部长度、假体头直径、背侧软组织状况及患者一般状况，都会影响手术结果和脱位频率。本文参考手术技术和患者选择描述了预防后方脱位的可能方法。还介绍了复发性脱位目前的手术治疗选择范围：组合式髋臼杯、双头髋臼杯、限制性髋臼杯、高偏移股骨颈及软组织干预措施。
