1、1 6 3 2 0 0 8 M2S SOrthopedicJournalofChinaVol.16,No.3Feb.2008Te:B(1968-), 3, D =,Dp V,Z_:1S,()010-620176917370 13511065187, (0Q)tian- “5 1 ys#) 田 华, 张 克, 刘 岩, 刘延青, 娄思权(v D S, gZ u 49| 100083)K1 “) 1 ? 3y、) #ZE。ZE11996 2004 M 1 850 ,? 3 7 , 34 , o3 ; ( M -67 ;YV -h N、 m 、 HW#? 3Z_$)y、) # 。TF?3 1 7 ,
2、 5 (5/7)Q 1 , 2 (2/7)J m ;4(4/7); m N;1 7 m *s, ;Z_ ( -; ( Hardinge 。L8Z2 (2/7)v55。? 3 HW1 ? 27, 5 ? 3 3 =。 7 ( n5 J/、/ 6 , 6 i?;1 3 = 2Q,iV? 3 ,m JZ。 1 By 1 m N、 ?vD B 、 m #L8 。v 7,# 6 r ZE,?sy VYVJ m 1。1oM:1; 1; ; ms |:R687.4 DS :A cI|:1005-8478 (2008)03-0182-03Causesandmanagementsofdislocationaft
3、ertotalhiparthroplastyTIANHua, ZHANGKe, LIUYan, etal.DeportmentofOrthopaedics, PekingUniversityThirdHospital, Beijing, 100083, ChinaAbstractObjective Toapproachthecausesandmanagementsofdislocationaftertotalhiparthroplasty.Methods850totalhiparthroplastiesweredoneinourdepartmentfrom1996to2004, inwhich
4、7casesexperiencedpost-operativedisloca-tion.Whith4malesand3females, theaverageagewas67yearsold.Causesandmanagementshavebeenstudiedretrospectivelythroughanalysisofhistory, surgicalapproach, timinganddirectionofthedislocationsandpredisposingfactorsofthedisloca-tionsoccurred.Results Therewer7 casesofdi
5、slocationsofwhich5patients(71%)wereprimarycasesand2patients(29%)wererevisioncases;4patients(57%)hadhistoryofhipsurgery;1casehadmentaldisorderaftercerebralsurger-y.Directlateralapproachwasusedforalthesepatients, andonlyanteriordislocationwasoccurredinthisgroup.ThroughstudytheAPX-rayspostoperatively,
6、theabductionangleweremorethan55degreein2ofthesecases.Thetimeofdislocationwasfromrightafteroperationto27 monthsafteroperation;5 ofthemexperiencedtheirdislocationwithin3 monthsafteropera-tion.Closedreductionand6weekstractionwereselectedforalthesepatients, and6ofthemweresuccessful.Recurrentdislcca-tion
7、occurredtwiceinanotheronepatientwithin3monthsafterreduction, andtheacetabularcupwasloosenedduringclosedre-duction.Astablejointwasachievedafterrevisionandmodifyingtheabductionangleofthecup.Conclusion Causativeriskfactorsfordislocationaftertotalhiparthroplastyincludesurgeryhistoryonthesamehip, inabili
8、tytocomplywithinstructionsofrehabilitation, approachofsurgeryandmalpositionoftheprosthesis.Closedreductionandtractionfor6-weekafterwardsareusu-allysuccessfulformostofthedislocatedcases.Revisioncouldbedoneinthebaseofanalyzingthereasonsforrecurentdisloca-tion, andthenstalejointcouldbeachieved.Keywords
9、:hipjoint; totalhiparthroplasty; postoperation; dislocation1(totalhiparthroplasty, THA) S W |B。 “ 、L8 !9# m T/ ?Z , m i? 3 qX A, EV h“。 THA Kn1851 6 3 2 0 0 8 M2S SOrthopedicJournalofChinaVol.16,No.3Feb.2008i?B,Q 1 ? 3 q1%3%,7J m q5 Vr5% 20%13。YV 1 m ? 37 $,) y、ZE# n 。1 “5 ZE19962004 M, 1850 。 ? 3 7
10、 。 34 , o3 ; ( M -67 (6275 )。 5 Q 1 , 2 Jm 。 4 ; m N;1 7 m *s, 。 ( Har-dinge 。 L8Z ( 。? 3HW1 27。 7 ( n5 J/,/ 6。 6 , 61 3 = ? 3 Q,i OV , m JZ。2 TF 1 7 , ( HW4.9 M(2 9 M), h 0.82%。 5 Q1 , 2 J m 。 4 ; m N;1 7 m *s, ; ( Hardinge 。 L8Z ?C2 v55。 5 ? 3 3 =,K 1 ? 3,K1? 3 2 M3, 。 7 ( n5 J/、/ 6 , 5i? 3?;2 3 =
11、 ? 3 Q, m JL8。h : o, 68 ,y5? 、1 1 J/ 1 。 2 H y, H? 3,3 =Q? 3,iV? 3 。 BJ m iZ, 2 M? 3(m14)。m1 -XL U? 、 1m2 1 2m3V m4J 2.5M,? 33 ) 1 Kni?B。 qEB(0.6% 7%), MorreyYV16 11 D 8 ,?C35 894 1804 (2.24%)? 3 1。yN, Y 1 3 1yB,AF j,-%syi 。? 3 1 y,987 Vs1 m N,9F1 B2。F7 4 (57%)i; m N, 2 ;“ h , 62 5sYy“ h Y HW |7 V m
12、 。yN,; m N 1 H - 9, iL8b, B ? 3B。8 * “d%( 7 L)、 *h#p?h, h # vD ? 9 ny;Fackler?Cr22% ? 3,i O75%?。F1 7 L, -/ ), 2? 3 。yN,B“ hGirdlstone m a 。m M1y 1 ? 31y, m 、 m D 3、 Ff 、L8b。 m 1 ? 3+ qB1“。WooYV8 DV 1 ? 3 s,?C q(3.23%)1 A - (2.18%) (0.55%)3。 DYV1 5#1861 6 3 2 0 0 8 M2S SOrthopedicJournalofChinaVol.16
13、,No.3Feb.2008 ZE V A ? 3 q4。F ( ( Hardinge ),98q0.82%。T8 l,1 L8a q。1 M g Ff m D39 ? 3 y。 7, Ff y 、l 、 4D#“ L8 4 l5。Fh ( 1FD 3 m , (| 、l %v0, ? , Fq 1y。? 3 1 6B1y L8b 。B ,L8Z3545W M S,NS 1 q9F46。 D Lima9 _1 E L?CZ45 55W KS,VlZ 1 y w H? 3 7。Fh 2Zv55。T ZKz1V45,VvZ ?9F B。“ L8 - s9 3y 。 a- S 15 20。 - 1 p
14、BY, H - aFv,7 -Z H ahl8。L8 !9y 1 ? 3“1T。h1 qVl H, S = Y = ,9 3 、 b C#s v V7? 39。122 mm“ h ? 28mm32mmL8h9F? 3 q5, “ - ip。V 22mm“ hh-1 ql,V7? 3 。? 3 HWsy (B。 3 =* 4D、1 5# F +, VL,. 1 F 5J.S S, 2007, 3:231-232.3 MasonisJL,BourneRB.Surgicalapproach,abductorfunctionandtotalhiparthroplastydislocationJ.Cli
15、nOrthop, 2002, 405:46-53.4 WhiteRE,FornessTJ,AlmanJK,etal.Efectofposteriorcapsularre-paironearlydislocationinprimarytotalhipreplacementJ.ClinOr-thop, 2001, 393:163-167.5 DemosHA,RorabeckCH,BourneRB.InstabilityinprimarytotalhiparthroplastywiththedirectlateralapproachJ.ClinOrthop, 2001,393:168-180.6 B
16、arrackRL.Dislocationsaftertotalhiparthroplasty:implantdesignandorientationJ.JAmAcadOrthopSurg, 2003, 11:89-99.7 DLima,UrquhartAG,BuehlerKO,etal.Theefectoftheorientationoftheacetabularandfemoralcomponentsontherangeofmotionofthehipatdiferenthead-neckratiosJ.JBoneJointSurgAm, 2000, 82:315-321.8 RobbinsGM,MasriBA,GarbuzDS,etal.TreatmentofhipinstabilityJ.OrthopClinNorthAm, 2001, 32:593-610.9 SoongM,RubasbHE,MacaulayW.Dislocationaftertotalhiparthro-plastyJ.JAmAcadOrthopSurg, 2004, 12:314-321.( l:2007-06-06 :2007-10-25)187
