摘要
学术背景:目前,全髋关节置换被广泛的应用于治疗晚期的髋关节骨关节炎、类风湿性关节炎、股骨头缺血坏死等疾病。虽然手术的效果比较肯定,但置换后髋关节不稳定等并发症越来越引起人们的关注。目的:综述髋关节置换后不稳定的研究现状。检索策略:应用计算机检索PubMed数据库1997-01/2007-11的有关文献,检索词为"hipreplacement,dislocation",限定文章语言为英语。共检索到496篇相关文献,其中论著445篇,综述51篇,对文献进行筛选,纳入标准:①探讨髋关节脱位的影响因素方面的文章。②髋关节脱位的预防和治疗方面的文章。③选取针对性强,相关度高的文献。④对同一领域的文献选择近期发表或权威杂志的文献;排除重复研究和Meta分析类文章。文献评价:选用35篇文献,其中9篇为综述、其余均为临床与实验研究。资料综合:①全髋关节置换中,后外侧入路的脱位率较前外侧和直接外侧入路为高。后外侧入路在关闭伤口前,注意用可吸收线缝合后关节囊和外旋肌,加强后侧稳定因素,这样,后外侧入路与前外侧入路和直接外侧入路比较,脱位率没有显著的差别。②假体设计上讲,球头的直径越大,脱位风险越小。有裙的假体脱位率比无裙假体高。带高边的内衬可以减小脱位的风险。偏距的减少可以增加脱位的风险。③脱位在早期可以通过闭合复位达到治疗的目的。如果考虑感染引起,应及时切开清创,必要时取出假体,二期翻修。假体位置不当时必须调整,软组织不平衡的髋关节也常需再次手术。④如果患者反复脱位,外展肌力弱,有明显软组织不平衡的表现,或者无法明确脱位的原因,应考虑使用限制性髋臼假体。结论:髋关节置换后不稳定是一个多因素影响的复杂问题。随着研究的深入,髋关节置换后脱位的发生率明显下降。未来对于髋关节不稳定治疗的研究将主要围绕如何处理较复杂的各种原因引起的软组织不平衡所致的复杂性脱位展开。
BACKGROUND： Total hip replacement is frequently used for osteoarthritis, rheumatoid arthritis, avascular necrosis of femoral head, et al. Although the operation is effective, some complications such as dislocation are serious and arouse more attention. OBJECTIVE： To review the research status of dislocation after total hip arthroplasty. RETRIEVAL STRATEGY： A computer-based online search of PubMed was undertaken for the English articles published between January 1997 and November 2007 with keywords ＂hip replacement, dislocation＂. 496 related articles were collected from the above-mentioned database, including 445 original articles, and 57 review articles. Only articles （1）about the influential factors for dislocation of hip joint; （2）about the prevention and treatment of dislocation; （3）highly correlated with the objective; and （4） published in recently or in authoritative journals were selected. Repetitive studies and Meta analyses were excluded. LITERATURE EVALUATION： Thirty-five articles were included, of which 9 were review articles and the others were clinical or empirical studies. DATA SYNTHESIS： （1）Posterolateral approach in total hip arthroplasty increases the dislocation rate compared to anterior lateral approach and direct lateral approach. But when posterior articular capsule and extortor are sutured using absorbable thread before wound suture in total hip arthroplasty by posterolateral approach, the dislocation rate is increased and similar to anterior lateral approach and direct lateral approach. （2）Large ball head of prosthesis can decrease the incidence of dislocation. In addition, the incidence of dislocation in prosthesis with skirted is less than prosthesis with no skirt. Elevated-rim acetabular liner can decrease but small offset distance can increase incidence of dislocation. （3）Close reduction can cure early dislocation. If the dislocation is caused by infection, it is necessary to clear the wound, even take out the prosthesis for revision. Prosthesis location should be adjusted and hip joint with unbalance soft tissue should be treated by another surgery. （4）If patients with recurrent dislocation, weak abductor, obvious soft tissue unbalance or other reason, it is better to use constrained prosthesis. CONCLUSION： Dislocation after total hip arthroplasty is caused by lots of complicated factors. With the acquaintance of factors and development of surgery techniques, the dislocation rate is significantly reduced than before. Complicated dislocation caused by soft tissue unbalance is the focus of future research.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第13期2505-2510,共6页
Journal of Clinical Rehabilitative Tissue Engineering Research
