Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty
Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty
复制标题
DOI：
10.2106/jbjs.d.02860
复制
发表时间：
2005-11-01
影响因子：
5.3
通讯作者：
Harmsen, WS
中科院分区：
文献类型：
--
作者：
Berry, DJ;Von Knoch, M;Harmsen, WS
背景资料：据推测，使用一个较大的股骨头可以减少脱位的风险后，全髋关节置换术，但只有有限的临床数据已被提出作为证明这一hypothesis.Methods：从1969年至1999年，21,047原发性全髋关节置换术与不同的股骨头大小在一个机构进行。在规定的时间间隔内对患者进行常规随访，并特别询问脱位情况。9155例关节成形术的手术入路为前外侧，3646例为后外侧，8246例为经转子入路。股骨头直径22 mm者8691髋，28 mm者8797髋，32 mm者3559髋。结果：21,047髋中，868髋发生1个或1个以上脱位。首次脱位的累积风险在1年时为2.2%，5年时为3.0%，10年时为3.8%，20年时为6.0%。前外侧入路、经转子入路和后外侧入路的累积十年脱位率分别为3.1%、3.4%和6.9%。前外侧入路治疗的髋关节中，直径为22 mm的股骨头、28 mm的股骨头和32 mm的股骨头的累积十年脱位率分别为3.8%、3.0%和2.4%;经转子入路治疗的髋关节中，直径为22 mm的股骨头、28 mm的股骨头和32 mm的股骨头的累积十年脱位率分别为3.5%、3.5%和2.8%; 22 mm股骨头为12.1%，28 mm股骨头为6.9%，32 mm股骨头为3.8%。多变量分析显示，脱位的相对风险为1.7为22毫米相比，32毫米的头和1.3为28毫米相比，32毫米heads.Conclusions：在全髋关节置换术，较大的股骨头直径与脱位的长期累积风险较低。股骨头直径与所有手术入路相关，但与后外侧入路相关的影响最大。
Background: It has been postulated that use of a larger femoral head could reduce the risk of dislocation after total hip arthroplasty, but only limited clinical data have been presented as proof of this hypothesis.Methods: From 1969 to 1999, 21,047 primary total hip arthroplasties with varying femoral head sizes were performed at one institution. Patients routinely were followed at defined intervals and were specifically queried about dislocation. The operative approach was anterolateral in 9155 arthroplasties, posterolateral in 3646, and transtrochanteric in 8246. The femoral head diameter was 22 mm in 8691 of the procedures, 28 mm in 8797, and 32 mm in 3559.Results: One or more dislocations occurred in 868 of the 21,047 hips. The cumulative risk of first-time dislocation was 2.2% at one year, 3.0% at five years, 3.8% at ten years, and 6.0% at twenty years. The cumulative ten-year rate of dislocation was 3.1% following anterolateral approaches, 3.4% following transtrochanteric approaches, and 6.9% following posterolateral approaches. The cumulative ten-year rate of dislocation was 3.8% for 22-mm-diameter femoral heads, 3.0% for 28-mm heads, and 2.4% for 32-mm heads in hips treated with an anterolateral approach; 3.5% for 22-mm heads, 3.5% for 28-mm heads, and 2.8% for 32-mm heads in hips treated with a transtrochanteric approach; and 12.1% for 22-mm heads, 6.9% for 28-mm heads, and 3.8% for 32-mm heads in hips treated with a posterolateral approach. Multivariate analysis showed the relative risk of dislocation to be 1.7 for 22-mm compared with 32-mm heads and 1.3 for 28-mm compared with 32-mm heads.Conclusions: in total hip arthroplasty, a larger femoral head diameter was associated with a lower long-term cumulative risk of dislocation. The femoral head diameter had an effect in association with all operative approaches, but the effect was greatest in association with the posterolateral approach.