全髋关节置换术后脱位:危险因素及治疗方案分析

G. Alberton, W. High, B. Morrey
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Results: A dislocation occurred after 115 (7.4%) of 1548 revision hip arthroplasties. The use of an elevated rim liner was associated with significant decreases (p < 0.05) in dislocation following revision of femoral and acetabular components. The presence of trochanteric nonunion was a significant risk factor for subsequent dislocation (p < 0.001). Revisions with 32-mm and 28-mm-diameter femoral heads were both more stable than was revision with a 22-mm-diameter head (p < 0.05 for each). Surgery was the initial treatment for twelve of the 115 dislocations. Six of the twelve hips had no further instability. Of the 103 postoperative dislocations initially managed nonoperatively, only thirty-six did not redislocate. Thirty-eight of the sixty-seven hips that had an additional dislocation after closed treatment had repeat surgery for treatment of the instability. Only eleven of the thirty-eight hips were stable at one year after surgery. 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引用次数: 397

摘要

背景:脱位是翻修型全髋关节置换术失败的主要原因。虽然这一事实普遍得到公认,但我们知道迄今为止还没有对这一问题的详细评估。因此,我们的目的是评估导致翻修后不稳定的危险因素以及各种治疗策略的预期结果。方法:数据来自1405例患者的1548例翻修性关节置换术,随访至少2年(范围:2.0年至16.4年;平均8.1年)或直到脱位发生。由于不稳定性而进行的修订被排除在分析之外。风险因素与治疗策略及其成功一起被记录。计算两组变量的统计相关性。结果:1548例髋关节置换术翻修后发生脱位115例(7.4%)。在股骨和髋臼假体翻修后,使用升高的边缘衬套与脱位的显著减少相关(p < 0.05)。转子不愈合是继发脱位的重要危险因素(p < 0.001)。32 mm和28 mm股骨头矫正比22 mm股骨头矫正更稳定(p < 0.05)。手术是115例脱位中12例的初始治疗方法。12个髋关节中有6个没有进一步的不稳定。103例术后脱位最初采用非手术治疗,只有36例没有再脱位。67个髋关节中有38个在闭合治疗后发生额外脱位,需要重复手术来治疗不稳定。38个髋关节中只有11个在手术后一年保持稳定。总的来说,在最终评估时,115个髋关节中有65个(57%)是稳定的,41个(36%)仍然不稳定,9个(8%)的状态未知。结论:全髋关节翻修后不稳定的危险因素与初次手术后不同。软组织剥离的程度可能是最重要的变量,因为头部大小和粗隆不愈合与“软组织张力”有关。模块化髋臼组件与升高的边缘有助于稳定髋关节翻修程序。
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Dislocation After Revision Total Hip Arthroplasty: An Analysis of Risk Factors and Treatment Options
Background: Dislocation is a leading and underemphasized cause of failure in revision total hip arthroplasty. Although this fact is generally well recognized, we are aware of no detailed assessments of this problem to date. Our purpose therefore was to evaluate the risk factors leading to instability after revision as well as the expected outcome of various treatment strategies. Methods: Data were obtained from 1548 revision arthroplasties in 1405 patients who were followed for a minimum of two years (range, 2.0 to 16.4 years; mean, 8.1 years) or until dislocation occurred. Revisions specifically performed because of instability were excluded from the analysis. Risk factors were recorded along with treatment strategies and their success. The statistical relevance of both sets of variables was calculated. Results: A dislocation occurred after 115 (7.4%) of 1548 revision hip arthroplasties. The use of an elevated rim liner was associated with significant decreases (p < 0.05) in dislocation following revision of femoral and acetabular components. The presence of trochanteric nonunion was a significant risk factor for subsequent dislocation (p < 0.001). Revisions with 32-mm and 28-mm-diameter femoral heads were both more stable than was revision with a 22-mm-diameter head (p < 0.05 for each). Surgery was the initial treatment for twelve of the 115 dislocations. Six of the twelve hips had no further instability. Of the 103 postoperative dislocations initially managed nonoperatively, only thirty-six did not redislocate. Thirty-eight of the sixty-seven hips that had an additional dislocation after closed treatment had repeat surgery for treatment of the instability. Only eleven of the thirty-eight hips were stable at one year after surgery. Overall, at the time of the final assessment, sixty-five (57%) of the 115 hips were stable, forty-one (36%) remained unstable, and the status of nine (8%) was unknown. Conclusions: The risk factors for instability after a total hip revision are not the same as those after a primary procedure. The extent of the soft-tissue dissection is probably the most important variable since head size and trochanteric nonunion are related to "soft-tissue tension." Modular acetabular components with an elevated rim help to stabilize a hip undergoing a revision procedure.
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