Prevention and treatment of dislocation after total hip replacement using large diameter balls
Prevention and treatment of dislocation after total hip replacement using large diameter balls
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DOI：
10.1097/01.blo.0000150310.25603.26
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发表时间：
2004-12-01
影响因子：
4.2
通讯作者：
Beaulé, PE
中科院分区：
文献类型：
--
作者：
Amstutz, HC;Le Duff, MJ;Beaulé, PE
本研究的目的是审查的安全性和有效性。大直径股骨头置换术治疗和预防脱位。135例患者中140例髋关节采用直径至少36毫米的股骨头置换。患者平均年龄61.6岁。患者根据诊断分为三类：既往全髋关节置换术后复发性脱位（第一组，29髋）；不包括脱位翻修手术（第二组，54髋）；和初级手术（第3组；57髋）。平均随访时间为5.5年（1-17年）。共对16例髋关节进行了修正：6例因不稳定，4例因骨折或常规聚乙烯衬垫分离，3例因窝内无菌性松动，3例因败血症。I组一例髋关节术后12.5年脱位，经闭合复位治疗，此后无复发。UCLA髋部评分均显著提高。脱位的患病率在三组之间有所不同，1组为13.7%，2组为1.8%，3组为3.5%。6例因不稳定需要翻修的失败是由于椎窝定位不良。所有髋关节在翻修后均稳定，无需使用受限髋臼衬套。大直径股骨头不仅为复发性脱位患者提供了额外的稳定性，也为进行翻修的患者提供了额外的稳定性。新的，更耐磨的轴承现在使外科医生可以将大股骨头的使用扩展到初次全髋关节置换术。金属对金属似乎是大股骨头保存骨重建的首选材料。
The purpose of this study was to review safety and efficacy of. total hip arthroplasty using large-diameter femoral heads in treatment and prevention of dislocation. One hundred forty hips in 135 patients were replaced using femoral heads at least 36 mm in diameter. The average age of the patients was 61.6 years. The patients were grouped into three categories depending on their diagnoses: recurrent dislocations from previous total hip replacements (Group 1; 29 hips); revision surgeries not including revisions for dislocations (Group 2; 54 hips); and primary surgeries (Group 3; 57 hips). The average followup was 5.5 years (range, 1-17 years). A total of 16 hips were revised: six for instability, four for fracture or disassociation of a conventional polyethylene liner, three for aseptic loosening of the socket, and three for sepsis. One hip from Group I dislocated at 12.5 years postoperatively, was treated with closed reduction, and since has been nonrecurring. UCLA hip scores all improved significantly. The prevalence of dislocation varied among the three groups, with 13.7% for Group 1, 1.8% for Group 2, and 3.5% for Group 3. The failure in the six cases that required revision for instability was attributable to poor socket orientation. All the hips became stable after revision without the use of a constrained acetabular liner. Large-diameter femoral heads provide additional stability not only for patients with recurrent dislocations, but also for patients having revision. The new, more wear-resistant bearings now enable the surgeon to extend the use of big femoral heads to primary total hip arthroplasty. Metal-on-metal seems to be the material of choice for a bone-conserving reconstruction with large femoral heads.