Aota Shigeo, Kikuchi Shin-Ichi, Ohashi Hironori, Kitano Naoko, Hakozaki Michiyuki, Konno Shin-Ichi
Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima - Japan.
Hip Int. 2018 May;28(3):324-329. doi: 10.5301/hipint.5000573. Epub 2017 Oct 16.
Since dislocation after total hip arthroplasty (THA) greatly diminishes patient's quality of life, the THA frequently needs revision. However, it is common for the dislocation not to heal even after reconstruction, but rather to become intractable.
The 17 patients with dislocated THA, mean age of 71 years (range 51-87 years), who underwent a revision THA together with soft tissue reinforcement with a Leeds-Keio (LK) ligament were enrolled. The purposes of reinforcement with LK ligament were to restrict the internal rotation of the hip joint, and to encourage the formation of fibrous tissue in the posterior acetabular wall to stabilise the femoral head. We determined the success rate of surgical treatment for dislocation, the Harris Hip Score (HHS), a factor of recurrent dislocation.
There was no recurrent dislocation in 82% of the cases (14 joints) during the mean postoperative follow-up period of 63.5 months (15-96 months). The HHS was 82 ± 18 points preoperatively and 82 ± 14 points postoperatively. Recurrent dislocation after this surgical procedure occurred in 2 hips with breakage of the LK ligaments, and intracapsular dislocation in 1 hip with loosening of the LK ligament.
Although the risk of recurrent dislocation still exists with this procedure, when performed to provide reinforcement with an LK ligament for dislocated THA it may be useful in intractable cases with soft tissue defects around the hip joint.
由于全髋关节置换术（THA）后脱位会极大地降低患者的生活质量，因此THA常常需要翻修。然而，即使经过重建，脱位也常常无法愈合，反而变得难以处理。
纳入17例THA脱位患者，平均年龄71岁（范围51 - 87岁），这些患者接受了THA翻修术并使用利兹 - 庆应义塾（LK）韧带进行软组织强化。使用LK韧带强化的目的是限制髋关节的内旋，并促进髋臼后壁纤维组织的形成以稳定股骨头。我们确定了脱位手术治疗的成功率、Harris髋关节评分（HHS）以及复发性脱位的一个因素。
在平均63.5个月（15 - 96个月） 的术后随访期内，82%的病例（14个关节）未出现复发性脱位。术前HHS为82 ± 18分，术后为82 ± 14分。该手术操作后，2例髋关节因LK韧带断裂出现复发性脱位，1例髋关节因LK韧带松弛出现关节囊内脱位。
尽管该手术仍存在复发性脱位的风险，但对于THA脱位患者使用LK韧带进行强化时，在髋关节周围存在软组织缺损的棘手病例中可能是有用的。
