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1、人工全髖關節(jié)置換術后脫位發(fā)生率Theaverageincidenceofdislocationaftertotalhiparthroplastyisapproximately3%.factorsahistoryofprevioushipsurgeryorrevisiontotalhipreplacement(7.4%)aposteriorsurgicalapproach(5.8%vs2.3%)faultypositioningofoneorbothcomponentsimpingementofthefem
2、uronthepelvisorresidualosteophytesimpingementoftheneckofthefemoralcomponentonthemarginofthesocketinadequatesoft-tissuetensioninsufficientorweakabductormusclesavulsionornonunionofthegreatertrochanternoncomplianceorextremesofpositioningintheperioperativeper
3、iodfactorsAge,height,andweightdonotseemtobecausativefactorsinmanyseries,dislocationoccurredinwomenmoreoftenthaninmen.apreoperativediagnosisofosteonecrosis,proximalfemoralfractureornonunion,orinflammatoryarthritis.Likelycontributingfactorsincludeextensives
4、oft-tissuerelease,muscularweakness,smallfemoralheadsize(22mm),andtrochantericnonunion.后外側入路脫位高發(fā)的原因atendencytoretrovertthesocketnadequateanteriorretractionofthefemur,sotheacetabularpositioningdeviceisforcedposteriorlyduringcomponentinsertionDivisionofallth
5、eshortexternalrotators防止發(fā)生脫位的策略fixingthecupintheproperpositionjudgethepositionofthepatient'spelvisinthehorizontalandverticalplaneswomenwithbroadhipsandnarrowshouldersmenwithanarrowpelvisandbroadshoulderstruepositionofthepelvisalwaysmustbetakenintoaccount防
6、止發(fā)生脫位的策略Thefemoralcomponentshouldbefixedwiththeneckin5to10degreesofanteversion(15degreesisacceptable)developmentaldysplasiaorjuvenilerheumatoidarthritis,cancauseerrorinjudgingthecorrectposition(anteversion)Retroversionofthefemoralneckmaybeencounteredwiths
7、lippedcapitalfemoralepiphysis,oriftheneckisresectedatanexcessivelylowlevel.防止發(fā)生脫位的策略Boneorcementprotrudingbeyondtheflatsurfaceofthecupcancauseimpingementandmustberemovedafterthecuphasbeenfixedinplace.ifthegreatertrochanterisenlargedordistorted,someboneoft
8、enmustberemovedfromitsanteriororposteriormargintopreventimpingement.bonyimpingementismuchmorelikelyiffemoraloffsethasnotbeenadequatelyrestored.Theuseofafemoralcomponentwithenhancedoffsetcanbeverybeneficialinthissitu