影响人工全髋关节稳定性的因素及典型病例分析

发布时间：2018-06-01 00:41

本文选题：全髋关节置换术 + 脱位　；参考：《吉林大学》2015年硕士论文

【摘要】：人工全髋关节置换术是目前治疗严重的髋关节疾病，如股骨头坏死、髋关节骨性关节炎，先天性髋关节发育不良、强直性脊柱炎等最有效的方法，使患者的生活质量大大提升，基本可以使其像正常人一样参与日常活动。甚至有人提到运动员是否可在行全髋关节置换术后恢复运动生涯，但是并没有临床证据可以支持这一点，这有可能增加骨折及脱位的风险，并且影响远期效果[1]。全髋关节置换术也有一些并发症，不稳定的髋关节无论对于患者还是医生都是灾难性的。初次人工全髋关节置换术后的脱位率在1.1%-12.1%[2.3]，而初次脱位后再发脱位的概率则高达39%[3]。但随着近些年来手术技术的提高及假体设计的改变等诸多因素影响，初次置换的术后脱位率显著下降，约为2%左右[4.5]。对于行翻修术的患者，术后的脱位风险则更高，特别是只进行髋臼侧翻修的患者脱位率更高[6]，且随着翻修的次数增加脱位率也相应增加[7]。在Melvin JS等[8]人的研究中统计在1986-2000年间行THA手术的患者术后5年内翻修的患者中，关节不稳定和无菌性松动占到了70%。造成髋关节的不稳定因素是多种多样的，本文将通过对CNKI及pubmed数据库进行检索，以“THA、THR、dislocation、head size、approach、soft tissue、rehabilitation、prosthesis、acetabular、capsule、femur neck fracture、DDH等”检索词进行检索，总结影响人工全髋关节置换术后髋关节稳定性的影响因素，并对其进行分析，结合本科室典型病例进行分析，，总结预防及治疗的要点。结论：人工全髋关节置换术造成髋关节不稳定的因素是多方面的，1、患者本身的因素：高龄患者，肌肉力量差的患者及股骨颈骨折患者脱位率较常人要高；2、假体相关因素：不同的界面有不同的影响，金对金的界面相对金属碎屑要多，易造成关节的不稳定，而陶对陶的界面磨碎率低，但也同时存在陶瓷碎裂的风险，假体的安放要尽量置于安全区内，大直径的股骨头脱位率相对要低；3、手术技巧：后外侧入路脱位率相对要高，但也并非绝对，结合大头或软组织的修复，可与其它入路脱位率无大差异，假体周围软组织的重建可显著降低术后的脱位率；4、术后的康复锻炼要因人而异，早期功能锻炼，避免过度屈曲、内旋、内收髋关节的动作。近年来随着手术技术的提升，假体设计及材料的进步，全髋关节置换术后的脱位及松动率都已经得到大大的改善。绝大多数患者的关节不稳定都不是单一因素造成的，其间是相互影响的，我们要尽量确保每一步操作的准确性，从而使得手术更加成功。
[Abstract]:Total hip replacement is the most effective method for the treatment of serious hip diseases, such as osteonecrosis of the femoral head, osteoarthritis of the hip joint, congenital dysplasia of the hip joint, ankylosing spondylitis, and so on. The quality of life of the patients is greatly improved. It can basically make it participate in daily activities like normal people. There is even talk of whether athletes can resume their athletic life after total hip replacement, but there is no clinical evidence to support this, which may increase the risk of fractures and dislocations and affect long-term outcomes [1]. Total hip replacement also has some complications, unstable hip joint is catastrophic for both patients and doctors. The rate of dislocation after primary total hip replacement was 1.1% -12.1% [2.3], while the probability of recurrent dislocation was as high as 39% [3]. However, with the improvement of surgical technique and the change of prosthesis design in recent years, the dislocation rate of primary replacement decreased significantly, about 2% [4.5]. For patients undergoing revision, the risk of dislocation was higher, especially in patients with acetabular lateral revision [6], and the dislocation rate increased accordingly with the increase of revision times [7]. In the study of Melvin JS et al. [8], it was estimated that the joint instability and aseptic loosening accounted for 70% of the patients undergoing THA operation within 5 years after operation from 1986 to 2000. There are many kinds of unstable factors in hip joint. In this paper, CNKI and pubmed databases are searched with the key words, such as "tha THR dislocation-head size approval tissue rehabilitation", "acetabularcapsule femur neck fracture", etc. The factors affecting the stability of the hip joint after total hip arthroplasty were summarized and analyzed. The main points of prevention and treatment were summarized in combination with the typical cases in this department. Conclusion: the factors of hip instability caused by total hip replacement are multiple factors. The dislocation rate of patients with poor muscle strength and femoral neck fracture was 2% higher than that of normal people. The factors related to prosthesis were: different interfaces had different effects, and the interface of gold was more than that of metal fragments, which easily caused instability of joint. However, the interfacial grinding rate of Tao to Tao is low, but at the same time there is the risk of ceramic fragmentation. The prosthesis should be placed as far as possible in the safety zone, the dislocation rate of large diameter femoral head should be relatively low, and the surgical technique: the dislocation rate of the posterolateral approach is relatively high. But it is not absolute. The rate of dislocation can not be significantly different from that of other approaches combined with the repair of large head or soft tissue. The reconstruction of soft tissue around the prosthesis can significantly reduce the rate of dislocation after operation. The rehabilitation exercise after operation should be different from person to person, and early functional exercise should be done. Avoid excessive flexion, internal rotation, and adductive hip movements. In recent years, with the improvement of surgical technology, the design of prosthesis and the progress of materials, the dislocation and loosening rate of total hip arthroplasty have been greatly improved. Most patients' joint instability is not caused by a single factor, and it is mutual influence. We should try to ensure the accuracy of each step to make the operation more successful.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.42

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