Roth A, Goralski S, Layher F, Fakler J, Ghanem M, Pempe C, Hennings R, Spiegl U, Zajonz D
Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie Bereich Endoprothetik/Orthopädie, Universitätsklinik Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
Deutsches Zentrum für Orthopädie, Professur für Orthopädie des Universitätsklinikums Jena, Waldkliniken Eisenberg, Jena, Deutschland.
Orthopade. 2019 Apr;48(4):300-307. doi: 10.1007/s00132-019-03694-w.
Endoprosthetic care of high hip dislocation is a surgical challenge. The hip anatomy is greatly altered in these patients, including a rather flat and small acetabulum with impaired bone quality and a relevant chance of a bony defect of the acetabular roof. Additionally, the front coverage and in some cases even the dorsal coverage of the hip are missing. The proximal femur is characterized with an increased antetorsion, a coxa valga position and an enlarged greater trochanter. The medullary cavity is narrowed, the offset is reduced, and the absolut leg length can be enlarged. Further anatomic variations can have been caused by previous surgeries.
The goal of the endoprosthetic care is the re-creation of a hip with an anatomic center of rotation, an anatomic offset and equal leg length.
This can be achieved by a medial shift of the acetabular cup. An acetabular osteotomy including central cancellous bone graft or a bony graft to reinforce the acetabular roof might be necessary. In cases in which an anatomic acetabular cup placement is not possible, a more cranial placement can be done. Further strategies that are essential in several cases are shortening or re-orientation osteotomies of the femur, reaming of the medullary cavity and correct implant selection. Additionally, thorough soft tissue management is of main importance. Generally, the surgery should be well prepared preoperatively.
高位髋关节脱位的人工关节置换治疗是一项外科挑战。这些患者的髋关节解剖结构发生了很大改变，包括髋臼相当扁平且小，骨质受损，髋臼顶存在骨缺损的相关可能性。此外，髋关节的前方覆盖甚至在某些情况下后方覆盖也缺失。股骨近端的特点是前倾角增加、髋外翻位以及大转子增大。髓腔变窄，偏移减小，绝对腿长可能增加。先前的手术可能导致了进一步的解剖变异。
人工关节置换治疗的目标是重建一个具有解剖旋转中心、解剖偏移和等长下肢的髋关节。
这可以通过髋臼杯的内侧移位来实现。可能需要进行包括中央松质骨移植或骨移植以加强髋臼顶的髋臼截骨术。在无法进行解剖学髋臼杯放置的情况下，可以进行更高位的放置。在一些情况下必不可少的其他策略包括股骨缩短或重新定向截骨术、髓腔扩髓以及正确的植入物选择。此外，彻底的软组织处理至关重要。一般来说，手术应在术前做好充分准备。
