初次全髋关节置换术后早期脱位的临床特点及处理策略  

Clinical characteristics and treatment strategy of early dislocation after primary total hip arthroplasty

作　　者：谢峰 周怡利 徐明灯 王炳辉 唐祝 蒋电明 XIE Feng;ZHOU Yili;XU Mingdeng;WANG Binghui;TANG Zhu;JIANG Dianming(Department of Orthopedic Surgery,The Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China)

机构地区：[1]重庆医科大学附属第三医院骨科,重庆401120

出　　处：《中华骨与关节外科杂志》2019年第9期686-689,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:初次全髋关节置换术疗效良好,是目前最成功的骨科手术之一。但脱位是初次全髋关节置换术后早期常见且严重的的并发症。目的:探讨初次全髋关节置换术后早期脱位的临床特点及处理策略。方法:回顾分析2010年3月至2018年7月行初次全髋关节置换术患者560例,其中发生早期术后脱位8例(术后≤3个月),男3例,女5例,年龄45~76岁,平均61.5岁。收集患者一般情况、手术情况、脱位方向、发生脱位时间及处理方式。结果:8例患者术后随访9~36个月,平均18个月。本组初次全髋关节置换术后早期脱位发生率为1.4%(8/560),其中5例为前脱位(0.89%),3例为后脱位(0.53%);7例(1.20%)脱位发生在术后2周内,1例(0.17%)发生在术后3个月。7例脱位经闭合复位支具固定获得治愈,1例经翻修手术获得稳定。所有患者在随访期间均未再次出现脱位。结论:对大多数初次全髋关节置换术后早期脱位的患者通过闭合复位外固定的处理方式能获得成功,无需手术,但反复脱位、假体位置极度不良者应予翻修手术处理。Background:Primary total hip arthroplasty(THA)is one of the most successful orthopaedic surgeries at present,but dislocation is a common and serious complication in the early stage after primary THA.Objective:To investigate the features and treatment strategy of early dislocation after primary THA.Methods:Eight of 560 patients undergoing primary THA from March 2010 to July 2018,experienced early postoperative dislocation(≤3 months).There were 3 males and 5 females with an average age of 61.5 years(range,45-76 years).General information,surgical approach,timing and direction of the dislocations were retrospectively investigated.Results:The mean duration of follow-up was 18 months(range,9-36 months).The incidence of early dislocation after primary THA was 1.4%(8/560)in this study.There were 5 cases of anterior dislocation(0.89%)and 3 cases of posterior dislocation(0.53%).The dislocation occurred within 2 weeks postoperatively in 7 cases and at3 months postoperatively in 1 case.Seven cases of dislocation were successfully fixed by closed reduction.One case was successfully fixed by manipulation and then dislocation occurred again within the same day.After revision,the dislocation was stabilized.No dislocation occurred again at the last follow-up.Conclusions:Most patients with early dislocation after THA can be successfully treated by closed reduction and external fixation,but for patients with repeated dislocation and extremely poor prosthesis position,surgical revision should be performed.

关 键 词：全髋关节置换术 脱位 

分 类 号：R687.4[医药卫生—骨科学]