Hartofilakidis G, Stamos K, Karachalios T
Orthopaedic Department, Athens University, K.A.T. Hospital, Greece.
J Bone Joint Surg Am. 1998 Apr;80(4):510-7. doi: 10.2106/00004623-199804000-00007.
The clinical results of eighty-four total hip arthroplasties performed through a transtrochanteric approach in sixty-seven patients who had a high dislocation of the hip (the femoral head completely out of the acetabulum), from 1976 to 1994, were reviewed. The acetabular component was placed in the true acetabulum and the femur was shortened at the level of the femoral neck, along with release of the psoas tendon and the small external rotators, in order to facilitate reduction of the components and to avoid neurovascular complications. Eleven hip prostheses (13 per cent) failed at a mean of 6.4 years (range, two months to sixteen years) postoperatively; the failure was due to aseptic loosening of both components in four hips, aseptic loosening of the stem only in three, late infection in three, and malpositioning of the acetabular component that caused recurrent dislocations in one. The other seventy-three hips were functioning well at the latest follow-up examination, two to twenty years (mean, 7.1 years) postoperatively. The overall cumulative rate of success was 92.4 per cent (95 per cent confidence interval, 89.5 to 95.3 per cent) at five years and 88.0 per cent (95 per cent confidence interval, 82.2 to 93.8 per cent) at ten years. We believe that this operative technique of total hip arthroplasty is effective for the treatment of the difficult condition of high dislocation of the hip.
回顾了1976年至1994年间，对67例髋关节高位脱位（股骨头完全脱出髋臼）患者采用经转子入路进行的84例全髋关节置换术的临床结果。髋臼组件置于真髋臼内，股骨在股骨颈水平缩短，同时松解腰大肌腱和小外旋肌，以利于组件复位并避免神经血管并发症。11例髋关节假体（13%）在术后平均6.4年（范围为2个月至16年）失败；失败原因包括4例双侧组件无菌性松动、3例仅柄无菌性松动、3例晚期感染以及1例髋臼组件位置不当导致反复脱位。其他73例髋关节在术后2至20年（平均7.1年）的最新随访检查中功能良好。五年时总体累积成功率为92.4%（95%置信区间为89.5%至95.3%），十年时为88.0%（95%置信区间为82.2%至93.8%）。我们认为这种全髋关节置换手术技术对于治疗髋关节高位脱位这一困难病症是有效的。
