Jones Carl, Briffa Nikolai, Jacob Joshua, Hargrove Richard
SpR in Trauma and Orthopaedics Waikato Hospital, Pembroke Street, Hamilton, New Zealand.
Frimley Park Hospital, Portsmouth Road, Frimley, Surrey, United Kingdom St Georges Hospital, Blackshaw Road, Tooting, SW17 0QT, London, UK.
Open Orthop J. 2017 Oct 31;11:1200-1212. doi: 10.2174/1874325001711011200. eCollection 2017.
Hip hemiarthroplasty (HA) following an intracapsular neck of femur fracture is an increasingly common procedure as a result of an ageing population. Patients are often frail and so morbidity and mortality figures are significant. As a result the National Institute for Health and Clinical Excellence (NICE) has formulated guidelines and a Best Practice Tariff (BPT) in an attempt to improve the care of such patients. Dislocation following HA is a potentially devastating complication with a reported incidence ranging from 1 to 15%. Multiple causative factors have been cited and studied in an effort to reduce the incidence of this complication which has a high rate of recurrence following the first episode and is associated with a high mortality rate and significant financial burden on the health economy. This paper reviews the available literature in an effort to identify the most pertinent factors affecting dislocation rates and thus reduce the incidence of this serious complication.
A comprehensive review of the literature was performed using the search engine PubMed with the keywords 'hip', 'hemiarthroplasty' and 'dislocation'. Two hundred and forty three articles were identified and assessed by the 3 authors independently. Data from fifty-two articles pertinent to the review on hemiarthroplasty dislocation epidemiology, risk factors and management were extracted in a standardised fashion.
Following review of the papers multiple causative factors relating to HA dislocation were identified and grouped into 4 broad categories for analysis. The factors with the strongest correlation with dislocation included patient cognition, previous failed surgery, delay to surgery, surgical approach and femoral offset.
Hip hemiarthroplasty remains the gold standard for elderly patients with intracapsular neck of femur fractures. In each individual case the factors most strongly associated with postoperative dislocation should be recognised. Delays to surgery should be minimised and the posterior approach avoided. In addition to good surgical technique, particular attention should be paid to restoring the patient's native femoral offset and post operatively those with cognitive impairment should be closely monitored.
由于人口老龄化，股骨颈囊内骨折后行半髋关节置换术（HA）的情况日益普遍。患者通常身体虚弱，因此发病率和死亡率都很高。为此，英国国家卫生与临床优化研究所（NICE）制定了指南和最佳实践收费标准（BPT），以改善对此类患者的护理。HA术后脱位是一种潜在的严重并发症，报道的发生率在1%至15%之间。为了降低这种并发症的发生率，人们列举并研究了多种致病因素，该并发症首次发作后复发率很高，且与高死亡率以及对卫生经济造成的巨大负担相关。本文回顾了现有文献，以确定影响脱位率的最相关因素，从而降低这种严重并发症的发生率。
使用搜索引擎PubMed，以“髋关节”“半髋关节置换术”和“脱位”为关键词进行了全面的文献综述。三位作者独立识别并评估了243篇文章。以标准化方式提取了52篇与半髋关节置换术脱位流行病学、危险因素及处理相关综述的文章数据。
在对这些论文进行综述后，确定了与HA脱位相关的多种致病因素，并将其分为4大类进行分析。与脱位相关性最强的因素包括患者认知、既往手术失败、手术延迟、手术入路和股骨偏心距。
半髋关节置换术仍然是老年股骨颈囊内骨折患者的金标准。在每个病例中，应识别出与术后脱位最密切相关的因素。应尽量减少手术延迟，避免采用后路入路。除了良好的手术技术外,应特别注意恢复患者的天然股骨偏心距，术后应对认知障碍患者进行密切监测。
