Hedlundh U, Ahnfelt L, Hybbinette C H, Wallinder L, Weckström J, Fredin H
Department of Orthopaedics, Malmö University Hospital, Sweden.
Clin Orthop Relat Res. 1996 Dec(333):226-33.
The dislocation rate of 3197 Charnley prostheses with 22 mm head in which the surgery was done between 1979 and 1991 in 2 orthopaedic centers was compared with that of 2875 Lubinus prostheses with 32 mm head in which the surgery was done between 1980 to 1991 in 3 other centers. A 1-year followup showed an equal rate of dislocation (2.4%-2.5%) in the 2 groups and included 75% of the 201 dislocated hips. Almost all of the late dislocations occurred with the Charnley prosthesis, resulting in a total dislocation rate of 3.7% compared with 2.9% with the Lubinus prosthesis. Regardless of the type of prosthesis used, there was a higher risk of dislocation in patients with nonhealed hip fractures and in arthroplasties performed by less experienced surgeons. When these 2 variables were removed, the small femoral head was not associated with an increased risk of dislocation. However, there were 77 of 118 (65%) recurrent dislocations in the Charnley group, compared with 37 of 83 (45%) in the Lubinus group, and the relative risk of a dislocated hip arthroplasty becoming recurrent increased by 2.3 times if the small femoral head was used. The number of reoperations also were doubled in this group. Almost 4 times as many dislocations were documented within 2 weeks after surgery after any type of prosthesis inserted through a posterior approach compared with the transtrochanteric approach, but there was no increase in rate of recurrence or revision.
对1979年至1991年期间在2家骨科中心采用22毫米股骨头的3197例Charnley假体置换手术的脱位率，与1980年至1991年期间在其他3家中心采用32毫米股骨头的2875例Lubinus假体置换手术的脱位率进行了比较。1年的随访显示，两组的脱位率相同（2.4%-2.5%），201例脱位髋关节中有75%在此范围内。几乎所有的晚期脱位都发生在Charnley假体组，导致其总脱位率为3.7%，而Lubinus假体组为2.9%。无论使用何种类型的假体，未愈合髋部骨折患者以及由经验较少的外科医生进行的关节置换手术中脱位风险更高。当去除这两个变量时，小股骨头与脱位风险增加无关。然而，Charnley组118例复发性脱位中有77例（65%），而Lubinus组83例中有37例（45%），如果使用小股骨头，髋关节置换术后脱位复发的相对风险增加2.3倍。该组再次手术的次数也增加了一倍。与经转子间入路相比，通过后入路植入任何类型假体后，术后2周内记录的脱位数量几乎是其4倍，但复发率或翻修率没有增加。
