Perka C, Haschke F, Tohtz S
Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie und Klinik für Unfall- und Wiederherstellungs-chirurgie, Charité, Berlin.
Z Orthop Unfall. 2012 Apr;150(2):e89-103, quiz e104-5. doi: 10.1055/s-0031-1298419. Epub 2012 Apr 12.
Dislocations after total hip arthroplasties are one of the most common complications of the procedure. According to registers, recurrent hip dislocations account for up to 30 % of the indications for a revision operation. The incidence of a dislocation is influenced by indication-associated, patient-dependent and operation-specific risk factors. 50 % of the dislocations occur within the first 3 months which confirms the high relevance of operation-specific influencing factors. The diagnosis is almost always made with the help of computed tomography, as this is the only method to determine the three-dimensional relationship of the components. A dynamic fluoroscopic examination can verify an increased translation (reduced soft-tissue tension) and thus enables a functional examination to determine the mechanism of the dislocation. By means of a classification of dislocations into five types under consideration of the implant position, the sufficiency of the pelvitrochantar musculature, the presence of an impingement, the congruence of head and acetabular liner as well as combinations of these factors it is possible to plan an adequate therapy. From the therapeutic point of view the correct positioning of the stem and head is of decisive importance. In addition therapeutic success can be realized by using larger head diameters through to tripolar sockets, reconstruction of soft tissues and, last but not least, an adequate postoperative immobilization. Even so, this treatment is associated with a high rate of complications and in the literature failure rates of up to one third, i.e., the reoccurrence of a dislocation, are reported.
全髋关节置换术后脱位是该手术最常见的并发症之一。根据登记资料,复发性髋关节脱位占翻修手术指征的30%。脱位的发生率受指征相关、患者个体及手术特定风险因素的影响。50%的脱位发生在术后前3个月内,这证实了手术特定影响因素的高度相关性。诊断几乎总是借助计算机断层扫描进行,因为这是确定假体部件三维关系的唯一方法。动态荧光透视检查可证实平移增加(软组织张力降低),从而能够进行功能检查以确定脱位机制。通过根据植入物位置、骨盆转子间肌肉组织的充足性、撞击的存在、股骨头与髋臼内衬的匹配度以及这些因素的组合将脱位分为五种类型,有可能制定出适当的治疗方案。从治疗角度来看,假体柄和股骨头的正确定位至关重要。此外,通过使用更大的股骨头直径直至三极髋臼杯、重建软组织以及最后但同样重要的是进行充分的术后固定,可实现治疗成功。即便如此,这种治疗仍伴有高并发症发生率,且文献报道失败率高达三分之一,即脱位复发。