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[初次全髋关节置换术中的医疗过失:为何会有医疗过失条款?]

[Medical malpractice in primary total hip arthroplasty : Why is there a medical malpractice clause?].

作者信息

Innmann Moritz, Schiltenwolf Marcus

机构信息

Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.

出版信息

Orthopadie (Heidelb). 2025 Jul;54(7):537-542. doi: 10.1007/s00132-025-04664-1. Epub 2025 Jun 5.

DOI:10.1007/s00132-025-04664-1
PMID:40473832
Abstract

The provision of a hip endoprosthesis for coxarthrosis is one of the most common medical procedures associated with treatment errors. These errors are most frequently identified in the surgical execution. The most crucial prerequisite for preventing treatment errors is correct and guideline-compliant indication. Additionally, proper execution and documentation of both risk disclosure and precautionary disclosure are essential. Patient-specific factors, such as comorbidities or anatomical peculiarities, must be taken into account, as they are identified during mandatory preoperative planning. For postoperative radiological measurement parameters (e.g., implant positioning and leg length), clear and universally valid target values with acceptable deviations have not been definitively established. However, recommended values help assess whether an implantation error is present. Furthermore, a causal relationship between damage (e.g., dislocation, muscle weakness) and implantation errors must be established.

摘要

为髋关节炎提供髋关节假体是与治疗失误相关的最常见医疗程序之一。这些失误最常出现在手术执行过程中。预防治疗失误的最关键前提是正确且符合指南的适应症。此外,风险告知和预防措施告知的正确执行及记录至关重要。必须考虑患者特定因素,如合并症或解剖学特殊性,因为这些是在术前强制规划过程中确定的。对于术后放射学测量参数(如植入物位置和腿长),尚未明确确立具有可接受偏差的清晰且普遍适用的目标值。然而,推荐值有助于评估是否存在植入失误。此外,必须确定损伤(如脱位、肌肉无力)与植入失误之间的因果关系。

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本文引用的文献

1
Risk factors for increased sagittal pelvic motion causing unfavourable orientation of the acetabular component in patients undergoing total hip arthroplasty.导致全髋关节置换术后髋臼组件位置不良的矢状位骨盆运动增加的风险因素。
Bone Joint J. 2018 Jul;100-B(7):845-852. doi: 10.1302/0301-620X.100B7.BJJ-2017-1599.R1.
2
Additive Influence of Hip Offset and Leg Length Reconstruction on Postoperative Improvement in Clinical Outcome After Total Hip Arthroplasty.髋关节偏心距和下肢长度重建对全髋关节置换术后临床疗效改善的附加影响。
J Arthroplasty. 2018 Jan;33(1):156-161. doi: 10.1016/j.arth.2017.08.007. Epub 2017 Aug 12.
3
Combined anteversion technique for total hip arthroplasty.
全髋关节置换术的联合前倾角技术
Clin Orthop Relat Res. 2009 Jan;467(1):119-27. doi: 10.1007/s11999-008-0598-4. Epub 2008 Nov 1.