初级全髋关节置换术脱位:风险因素和预防方案分析

D. Regis, Mattia Cason, Bruno Magnan
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引用次数: 0

摘要

全髋关节置换术(THA)是骨科手术中最成功的选择性手术之一,可改善终末期关节疾病患者的疼痛和功能障碍。然而,脱位仍然是全髋关节置换术后一个棘手的并发症,因为它是导致翻修的主要原因,并与巨大的社会、健康和经济成本相关。脱位相对罕见,通常早期发生,取决于患者的特征和手术方式。最新的重要发现是术前应特别注意脊柱骨盆的活动度,这与脱位的发生率密切相关。因此,必须对腰椎进行临床和影像学评估,以确定骨盆倾斜度是否发生改变,因为骨盆倾斜度的改变可能暗示着椎间盘杯的不同位置。腰椎融合术目前被认为是脱位和翻修的风险因素,无论其是在 THA 之前还是之后进行。治疗和预防腰椎融合的手术方案包括使用股骨头直径较大的假体、双活动度结构、约束衬垫和模块化颈干。
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Dislocation of primary total hip arthroplasty: Analysis of risk factors and preventive options
Total hip arthroplasty (THA) is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease. However, dislocation continues to be a troublesome complication after THA, as it is a leading cause of revision and is associated with substantial social, health, and economic costs. It is a relatively rare, usually early occurrence that depends on both the patients’ characteristics and the surgical aspects. The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility, which is closely related to the incidence of dislocation. Consequently, clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup. Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA. Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size, dual mobility constructs, constrained liners, and modular neck stems.
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