【黄德勇】THA术后脱位与半脱位.pptxVIP

THA术后不稳定：危险因素和预防措施 Dislocation after THA：risks and prophylaxisHuang DeyongDepartment of adult joint reconstruction surgeryBeijing Jishuitan hospitalThe 4th hospital of Peking UniversityIncidence of THR dislocationVaries widely1-3% in 1° THR7-10% in revision THR60%: 6 weeks post -opClosed reduction: 70% successfulRevision surgery of recurrent instability60% successfulJST 1972.7—1986.6 244/204，脱位10髋，4.1% JST Now 1%Complications of THR SooHoo NF, Clin Orthop RelatRes. 2010;468:2363-71 138,399 patients managed with primary total hip arthroplasty in California from 1995 to 2005DislocationBozic et al: JBJS 91A:128, 200951,345 revision THRs10/2005 to 12/2006Causes:Dislocation (22.5%) loosening (19.7%)Infection (14.8%) Key to managementDetermine the aetiology of the dislocationOften multifactorialRisk FactorsPatientSurgicalProsthesisPatient risk factors（患者因素）Prior hip surgeryAgeFemaleDementia痴呆Neuromuscular / cognitive（认知） disorders75% of patients with recurrent THR dislocation14% of patients without THR dislocationMuscle weakness , imbalance, poor compliance（顺从）Incidence of THR dislocationVaries widely1-3% in 1° THR7-10% in revision THR60%: 6 weeks post -opClosed reduction: 70% successfulRevision surgery of recurrent instability60% successful限制性内衬+大粗隆下移Prosthesis risk factors（假体因素）Decreased head-neck ratioSmall head sizeSkirted femoral headsRound femoral neck geometryLiner profileHooded linersReduced offset 减小颈部直径Larger head size has been found to be a stabilizing factor in some series of primary and revision total hip arthroplasty, as reported by Berry et al. and Alberton, High, and Morrey.Large femoral headMaximizes head / neck ratioIncreases ROM before implant impingementGreater volume of the head needs to be displaced from the acetabulum for dislocation to occurLimited by size of acetabular shell insituMobile bearing hipSurgical risk factors（手术因素）Component malpositionAbductor insufficiencySurgical approachImpingementSurgeon experienceUsually multifactorialAntivesio