本文選題：全髖關節(jié)置換術 + 脫位��； 參考：《吉林大學》2015年碩士論文

【摘要】：人工全髖關節(jié)置換術是目前治療嚴重的髖關節(jié)疾病，如股骨頭壞死、髖關節(jié)骨性關節(jié)炎，先天性髖關節(jié)發(fā)育不良、強直性脊柱炎等最有效的方法，使患者的生活質量大大提升，基本可以使其像正常人一樣參與日�；顒�。甚至有人提到運動員是否可在行全髖關節(jié)置換術后恢復運動生涯，但是并沒有臨床證據(jù)可以支持這一點，這有可能增加骨折及脫位的風險，并且影響遠期效果[1]。全髖關節(jié)置換術也有一些并發(fā)癥，不穩(wěn)定的髖關節(jié)無論對于患者還是醫(yī)生都是災難性的。初次人工全髖關節(jié)置換術后的脫位率在1.1%-12.1%[2.3]，而初次脫位后再發(fā)脫位的概率則高達39%[3]。但隨著近些年來手術技術的提高及假體設計的改變等諸多因素影響，初次置換的術后脫位率顯著下降，約為2%左右[4.5]。對于行翻修術的患者，術后的脫位風險則更高，特別是只進行髖臼側翻修的患者脫位率更高[6]，且隨著翻修的次數(shù)增加脫位率也相應增加[7]。在Melvin JS等[8]人的研究中統(tǒng)計在1986-2000年間行THA手術的患者術后5年內翻修的患者中，關節(jié)不穩(wěn)定和無菌性松動占到了70%。造成髖關節(jié)的不穩(wěn)定因素是多種多樣的，本文將通過對CNKI及pubmed數(shù)據(jù)庫進行檢索，以“THA、THR、dislocation、head size、approach、soft tissue、rehabilitation、prosthesis、acetabular、capsule、femur neck fracture、DDH等”檢索詞進行檢索，總結影響人工全髖關節(jié)置換術后髖關節(jié)穩(wěn)定性的影響因素，并對其進行分析，結合本科室典型病例進行分析，，總結預防及治療的要點。結論：人工全髖關節(jié)置換術造成髖關節(jié)不穩(wěn)定的因素是多方面的，1、患者本身的因素：高齡患者，肌肉力量差的患者及股骨頸骨折患者脫位率較常人要高；2、假體相關因素：不同的界面有不同的影響，金對金的界面相對金屬碎屑要多，易造成關節(jié)的不穩(wěn)定，而陶對陶的界面磨碎率低，但也同時存在陶瓷碎裂的風險，假體的安放要盡量置于安全區(qū)內，大直徑的股骨頭脫位率相對要低；3、手術技巧：后外側入路脫位率相對要高，但也并非絕對，結合大頭或軟組織的修復，可與其它入路脫位率無大差異，假體周圍軟組織的重建可顯著降低術后的脫位率；4、術后的康復鍛煉要因人而異，早期功能鍛煉，避免過度屈曲、內旋、內收髖關節(jié)的動作。近年來隨著手術技術的提升，假體設計及材料的進步，全髖關節(jié)置換術后的脫位及松動率都已經得到大大的改善。絕大多數(shù)患者的關節(jié)不穩(wěn)定都不是單一因素造成的，其間是相互影響的，我們要盡量確保每一步操作的準確性，從而使得手術更加成功。
[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.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.42

【參考文獻】

相關期刊論文 前9條

1 袁鋒;蔡俊豐;周煒;馬敏;羅樹林;尹峰;;關節(jié)囊及外旋肌群修補在后外側入路初次全髖關節(jié)置換術的應用[J];生物骨科材料與臨床研究;2014年05期

2 吳慧敏;何愛詠;;經后側入路人工全髖關節(jié)置換保留關節(jié)囊對關節(jié)穩(wěn)定性的影響(英文)[J];中國組織工程研究與臨床康復;2008年26期

3 曹學偉;肖春生;呂燃;李想;;三種不同方法重建髖關節(jié)后關節(jié)囊防止髖關節(jié)置換術后脫位的比較研究[J];中國矯形外科雜志;2012年07期

4 沈鵬程;徐能;蔣富貴;朱立帆;翁峰標;王友華;;經后外側入路初次行人工全髖關節(jié)置換術外旋肌群與關節(jié)囊修復對預后的影響[J];中國修復重建外科雜志;2012年11期

5 孫啟才;王祥華;宋柏杉;朱芳兵;嚴世貴;;S-ROM假體全髖關節(jié)置換治療CroweⅣ型髖關節(jié)發(fā)育不良[J];中國骨傷;2013年02期

6 張江濤;尚延春;吳富源;曲廣運;;髖關節(jié)假體置換中股骨頭直徑及髖臼前傾角的作用[J];中國組織工程研究;2013年30期

7 徐步國;嚴世貴;王祥華;吳浩波;吳立東;何榮新;戴雪松;;全髖關節(jié)置換術治療強直性脊柱炎髖關節(jié)強直的中期療效隨訪[J];中國骨傷;2013年12期

8 聶涌;馬俊;胡欽勝;石小軍;裴福興;;髖臼假體放置角度對髖臼周圍應力分布的影響[J];醫(yī)用生物力學;2014年04期

9 Ivan De Martino;Georgios Konstantinos Triantafyllopoulos;Peter Keyes Sculco;Thomas Peter Sculco;;Dual mobility cups in total hip arthroplasty[J];World Journal of Orthopedics;2014年03期

本文編號：1962108