Stability of Total Hip Arthroplasty in Patients 75 Years or Older
Stability of Total Hip Arthroplasty in Patients 75 Years or Older
复制标题
75 岁或以上患者全髋关节置换术的稳定性
DOI：
10.1097/00003086-200212000-00008
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发表时间：
2002
影响因子：
4.2
通讯作者：
Elizabeth S. Soileau
中科院分区：
文献类型：
--
作者：
P. Lachiewicz;Elizabeth S. Soileau
患者年龄增加（> 75 岁）是全髋关节置换术脱位的已知危险因素。这是一项由一名外科医生对 75 岁或以上患者进行全髋关节置换术的研究，以确定脱位的发生率，并对预防和治疗该人群不稳定的手术方案进行审查。在对 75 岁或以上患者进行的 140 例初次全髋关节置换术中，随访至少 1 年，其中 82% 的术前诊断为骨关节炎，平均随访时间为 4 年。髋臼假体是无骨水泥的：在 121 例关节置换术中采用模块化，在 19 例关节置换术中采用骨水泥固定。共有 5 例脱位（3.5%），但只有 2 例复发，并且患者通过模块化组件交换成功治疗。双极关节置换术脱位率较低，但存在残余疼痛以及再次手术、磨损和骨质溶解率较高的问题。患有痴呆、外展肌功能不全或模块交换失败的老年患者可能需要使用受限部件。为了增加脱位发生之前的运动范围，大股骨头可以与高度交联的髋臼衬垫一起使用。模块化非骨水泥髋臼假体更适合 75 岁或以上的患者。建议使用 28 毫米或 32 毫米的股骨头，但骨折患者和治疗复发性脱位时应考虑使用更大的股骨头。
Increasing patient age (> 75 years) is a known risk factor for dislocation of total hip arthroplasty. This is a study of total hip arthroplasties by one surgeon in patients 75 years or older to determine the prevalence of dislocation and a review of the surgical options for prevention and treatment of instability in this population. Of 140 primary total hip arthroplasties done in patients 75 years or older who were followed up for at least 1 year, the preoperative diagnosis was osteoarthritis in 82% and the mean followup time was 4 years. The acetabular component was cementless: modular in 121 arthroplasties and cemented in 19 arthroplasties. There were five dislocations (3.5%), but only two were recurrent and the patients were treated successfully by modular component exchange. Bipolar arthroplasty has a lower rate of dislocation, but there are problems with residual pain and high rates of reoperation, wear, and osteolysis. Constrained components may be indicated in older patients with dementia, abductor insufficiency, or failure of modular exchange. Large femoral heads, to increase the range of motion before dislocation occurs, may be used with highly cross-linked acetabular liners. Modular cementless acetabular components are preferable in patients who are 75 years or older. A 28-mm or 32-mm femoral head is recommended, but larger femoral heads should be considered in patients with fractures and for the treatment of recurrent dislocation.