词条 | Hip dislocation |
释义 |
| name = Dislocation of hip | synonyms = | image = HipdisX.png | caption = X-ray showing a joint dislocation of the left hip. | pronounce = | field = Orthopedics | symptoms = Hip pain, trouble moving the hip[1] | complications = Avascular necrosis of the hip, arthritis[1] | onset = | duration = | types = Anterior, posterior[1] | causes = Trauma[1] | risks = | diagnosis = Confirmed by X-rays[5] | differential = Hip fracture, hip dysplasia[6] | prevention = Seat-belts[1] | treatment = Reduction of the hip carried out under procedural sedation[1] | medication = | prognosis = Variable[9] | frequency = Uncommon[10] | deaths = }} A hip dislocation a disruption of the joint between the femur and pelvis.[1] Specifically it is when the ball–shaped head of the femur comes out of the cup–shaped acetabulum of the pelvis.[1] Symptoms typically include pain and an inability move the hip.[1] Complications may include avascular necrosis of the hip, injury to the sciatic nerve, or arthritis.[1] Dislocations are typically due to significant trauma such as a motor vehicle collision or fall from height.[1] Often there are also other associated injuries.[5][2] Diagnosis is generally confirmed by plain X-rays.[5] Hip dislocations can also occur follow a hip replacement or from a developmental abnormality known as hip dysplasia.[3] Efforts to prevent the condition include wearing a seat-belt.[1] Emergency treatment generally follows advanced trauma life support.[5] This is generally followed by reduction of the hip carried out under procedural sedation.[1] A CT scan is recommended following reduction to rule out complications.[4] Surgery is required if the joint cannot be reduced otherwise.[5] Often a few months are required for healing to occur.[1] [5]Hip dislocations are uncommon.[6] Males are affected more often than females.[7] Traumatic dislocations occurs most commonly in those 16- to 40-year old.[8] The condition was first described in the medical press in the early 1800s.[9] {{TOC limit}}Signs and symptomsThe affected leg is virtually immovable by the person, and is usually extremely painful.[10] Dislocations are categorized as either posterior or anterior, based on the location of the head of the femur (see classification above).[11] Posterior dislocationNine out of ten hip dislocations are posterior.[12] The affected limb will be in a position of flexion, adduction, and internally rotated in this case.[12] The knee and the foot will be in towards the middle of the body.[10] A sciatic nerve palsy is present in 8%-20% of cases.[12] Anterior dislocationIn an anterior dislocation the limb is held by the person in externally rotated with mild flexion and abduction.[37] Femoral nerve palsies can be present, but are uncommon.[12] CauseDislocations of the hip typically take a high degree of force.[9] About 65% of cases are related to motor vehicle collisions, with falls and sports injuries being the cause of many of the rest.[9] MechanismThe hip joint includes the articulation of the femoral head (of femur) and the acetabulum of the pelvis. In hip dislocation, the femoral head is dislodged from this socket. Posterior dislocation is the most prevalent, in which the femoral head lies posterior and superior to the acetabulum. This is most common when the femur is adducted and internally rotated. The opposite is true for the shoulder, where the most common dislocation occurs in the anterior and inferior directions.[13] Motor vehicle traffic collisions are responsible for almost all posterior hip dislocations.[8] The posterior side of the hip exhibits primarily hip extension, dealing with the muscles: gluteus maximus, hamstring muscles (biceps femoris, semitendinosus, semimembranosus), and the six deep external rotators (piriformis, obturator externus, obturator internus, gemellus superior, gemellus inferior, and quadrates femoris).[14] To actually dislocate a healthy hip, a great amount of force needs to be applied. Motor vehicle accidents are the most common ways that hip dislocations occur. Falls from a height, such as a ladder, can also generate enough force to dislocate a hip. In older individuals, even a slight fall could cause this type of injury. Wear and tear that the body undergoes throughout the years leads to increased incidents of hip dislocation in the older population.[15] Several other injuries are also associated with hip dislocation. Fractures in the pelvis and legs, and minor back or head injuries can also occur, along with a hip dislocation, that is caused by a fall or athletic of injury. DiagnosisAnterior-posterior (AP) X-rays of the pelvis, AP and lateral views of the femur (knee included) are ordered for diagnosis.[12] The size of the head of the femur is then compared across both sides of the pelvis. The affected femoral head will appear larger if the dislocation is anterior, and smaller if posterior.[37] A CT scan may also be ordered to clarify the fracture pattern. ClassificationPosterior dislocationPosterior dislocations with an associated fracture are categorised by the Thompson and Epstein classification system, the Stewart and Milford classification system, and the Pipkin system (when associated with femoral head fractures).[17][18] Anterior dislocationThere is also a Thompson and Epstein classification system for anterior hip dislocations.[17][18] Central dislocationCentral dislocation is an outdated term for medial displacement of the femoral head into a displaced acetabular fracture.[18] It is no longer used. Hip dysplasia{{Further|X-ray of hip dysplasia}}Hip dysplasia is a condition in which a child is born with a hip problem. Hip dysplasia is when the formation of the hip joint is abnormal. The ball at the top of the thighbone which is known as the femoral head is not stable within the socket (which is also known as the acetabulum). Hip dysplasia is the preferred term because it provides a more accurate description of the spectrum of abnormalities that affect the immature hip.[19] The term "congenital" dislocation is no longer recommended, except for very rare conditions, in which there is a ("teratologic") fixed dislocation location present at birth.[12] ManagementUncomplicatedThe hip should be reduced as quickly as possible to reduce the risk of osteonecrosis of the femoral head.[8] This is done via inline manual traction with general anesthesia and muscle relaxation, or conscious sedation.[18] Fractures of the femoral head and other loose bodies should be determined prior to reduction. Common closed reduction methods include the Allis method and Stimson method.[20] Once reduction is completed management becomes less urgent and appropriate workup including CT scanning can be completed.[18] Post-reduction, people may begin early crutch-assisted ambulation with weight bearing as tolerated. ComplicatedIf the dislocated hip cannot be reduced by manipulation alone, an immediate open (surgical) reduction is necessary. A CT scan or Judet views should be obtained prior to transfer to the surgical suite.[18] RehabilitationHip dislocation rehabilitation can take anywhere from two to three months, depending on the person. Complications to nearby nerves and blood vessels can sometimes cause loss of blood supply to the bone, also known as osteonecrosis. The protective cartilage on the bone can also be disturbed from this type of injury. For this reason, it is important for people to contact a physician and get treatment immediately following injury.[15]
ExercisesIndividuals suffering from hip dislocation should participate in physical therapy and receive professional prescriptive exercises based on their individual abilities, progress, and overall range of motion. The following are some typical recommended exercises used as rehabilitation for hip dislocation. It is important to understand that each individual has different capabilities that can best be assessed by a physical therapist or medical professional, and that these are simply recommendations.[21]
Epidemiology16-40 year-old males are responsible for the majority of hip dislocations. These hip dislocations are typically posterior, and a direct result of motor vehicle traffic collisions.[8] Other animals{{Main|Dislocation of hip in animals}}References1. ^1 2 3 4 5 6 7 8 9 10 11 12 13 {{cite web |title=Hip Dislocation |url=https://orthoinfo.aaos.org/en/diseases--conditions/hip-dislocation |website=AAOS |accessdate=7 June 2018 |date=June 2014}} 2. ^{{cite journal |last1=Clegg |first1=TE |last2=Roberts |first2=CS |last3=Greene |first3=JW |last4=Prather |first4=BA |title=Hip dislocations--epidemiology, treatment, and outcomes. |journal=Injury |date=April 2010 |volume=41 |issue=4 |pages=329–34 |doi=10.1016/j.injury.2009.08.007 |pmid=19796765}} 3. ^{{cite book |last1=Callaghan |first1=John J. |last2=Rosenberg |first2=Aaron G. |last3=Rubash |first3=Harry E. |title=The Adult Hip |date=2007 |publisher=Lippincott Williams & Wilkins |isbn=9780781750929 |page=1032 |url=https://books.google.ca/books?id=-fwULYB1gJIC&pg=PA1032 |language=en}} 4. ^{{cite web |title=Hip Dislocations |url=https://www.merckmanuals.com/en-ca/professional/injuries-poisoning/dislocations/hip-dislocations |website=Merck Manuals Professional Edition |accessdate=7 June 2018 |language=en-CA |date=August 2017}} 5. ^{{cite book |last1=Clarke |first1=Sonya |last2=Santy-Tomlinson |first2=Julie |title=Orthopaedic and Trauma Nursing: An Evidence-based Approach to Musculoskeletal Care |date=2014 |publisher=John Wiley & Sons |isbn=9781118438848 |page=292 |url=https://books.google.ca/books?id=tJwDBAAAQBAJ&pg=PA292 |language=en}} 6. ^1 {{cite web |title=Hip Dislocation |url=https://www.orthobullets.com/trauma/1035/hip-dislocation |website=www.orthobullets.com |accessdate=7 June 2018 |language=en}} 7. ^1 {{cite book |last1=Blankenbaker |first1=Donna G. |last2=Davis |first2=Kirkland W. |title=Diagnostic Imaging: Musculoskeletal Trauma E-Book |date=2016 |publisher=Elsevier Health Sciences |isbn=9780323442954 |page=495 |url=https://books.google.ca/books?id=o0DUDAAAQBAJ&pg=PA495 |language=en}} 8. ^1 2 3 4 {{Cite book|title=Handbook of fractures|last=1967-|first=Egol, Kenneth A.|date=2015|publisher=Wolters Kluwer Health|others=Koval, Kenneth J., Zuckerman, Joseph D. (Joseph David), 1952-, Ovid Technologies, Inc.|isbn=9781451193626|edition=5th|location=Philadelphia|oclc=960851324|page=Chapter 27}} 9. ^1 2 3 4 5 6 7 {{cite journal |last1=Beebe |first1=MJ |last2=Bauer |first2=JM |last3=Mir |first3=HR |title=Treatment of Hip Dislocations and Associated Injuries: Current State of Care. |journal=The Orthopedic Clinics of North America |date=July 2016 |volume=47 |issue=3 |pages=527–49 |doi=10.1016/j.ocl.2016.02.002 |pmid=27241377}} 10. ^1 {{Cite web|url=http://orthoinfo.aaos.org/topic.cfm?topic=a00352|title=Hip Dislocation-OrthoInfo - AAOS|website=orthoinfo.aaos.org|access-date=2017-10-01}} 11. ^{{Cite journal|last=Goddard|first=N. J.|date=August 2000|title=Classification of traumatic hip dislocation|journal=Clinical Orthopaedics and Related Research|volume=377|issue=377|pages=11–14|issn=0009-921X|pmid=10943180|doi=10.1097/00003086-200008000-00004}} 12. ^1 2 3 4 5 {{Cite book|title=Essentials of musculoskeletal care|date=2010|publisher=American Academy of Orthopaedic Surgeons|others=Sarwark, John F.|isbn=9780892035793|location=Rosemont, Ill.|oclc=706805938}} 13. ^{{EMedicine|article|823471|Hip Dislocation in Emergency Medicine}} 14. ^Floyd, R.T. (2009). Manual of structural kinesiology. New York, NY: McGraw-Hill{{page needed|date=April 2014}} 15. ^1 {{cite web|url=http://orthoinfo.aaos.org/topic.cfm?topic=A00352 |title=Hip Dislocation-OrthoInfo - AAOS |publisher=Orthoinfo.aaos.org |date=2014-06-01 |accessdate=2015-03-01}} 16. ^{{cite journal|url=http://www.actaorthopaedica.be/acta/download/2008-5/06-Persiani%20et%20al.pdf|title=Hip subluxation and dislocation in cerebral palsy: Outcome of bone surgery in 21 hips|author1=Pietro PERSIANI|author2=Iakov MOLAYEM|year=2008|author3=Alessandro CALISTRI|author4=Stefano ROSI|author5=Marco BOVE|author6=Ciro VILLANI|journal=Acta Orthop. Belg.}} 17. ^1 {{Cite journal|last=Thompson|first=Vernon P.|last2=Epstein|first2=Herman C.|date=July 1951|title=TRAUMATIC DISLOCATION OF THE HIP: A Survey of Two Hundred and Four Cases Covering a Period of Twenty-one Years.|url=http://journals.lww.com/jbjsjournal/Abstract/1951/33030/TRAUMATIC_DISLOCATION_OF_THE_HIP__A_Survey_of_Two.23.aspx|journal=JBJS|volume=33|issue=3|pages=746|issn=0021-9355|doi=10.2106/00004623-195133030-00023}} 18. ^1 2 3 4 5 6 7 {{Cite book|title=Skeletal trauma : basic science, management, and reconstruction|others=Browner, Bruce D.,, Jupiter, Jesse B.,, Krettek, Christian, 1953-, Anderson, Paul, 1952-, ClinicalKey.|isbn=9781455776283|edition=Fifth|location=Philadelphia, PA|oclc=898159499|last1 = Browner|first1 = Bruce D.|last2=Jupiter|first2=Jesse B.|last3=Krettek|first3=Christian|last4=Anderson|first4=Paul|date=2014-12-09}} 19. ^{{Cite journal|last=Jackson|first=Jonathan C.|last2=Runge|first2=Melissa M.|last3=Nye|first3=Nathaniel S.|date=2014-12-15|title=Common Questions About Developmental Dysplasia of the Hip|url=http://www.aafp.org/afp/2014/1215/p843.html|journal=American Family Physician|language=en|volume=90|issue=12|issn=0002-838X}} 20. ^{{Cite book|url=https://archive.org/details/treatiseonfractu00stim|title=A treatise on fractures|last=Stimson|first=Lewis Atterbury|date=1883|publisher=Philadelphia, H.C. Lea's son & co.|others=The Library of Congress}} 21. ^1 2 3 4 5 6 7 8 9 10 11 12 {{EMedicine|article|86930|Hip Dislocation Treatment & Management}} External links{{Medical resources| DiseasesDB = 3056 | ICD10 = {{ICD10|S|73|0|s|70}}, {{ICD10|Q|65|0|q|65}}-{{ICD10|Q|65|2|q|65}} | ICD9 = {{ICD9|835}} | ICDO = | OMIM = 142700 | MedlinePlus = | eMedicineSubj = emerg | eMedicineTopic = 144 | MeshID = D006618 }}{{Congenital malformations and deformations of musculoskeletal system}}{{Dislocations, sprains and strains}} 3 : Congenital disorders of musculoskeletal system|Dislocations, sprains and strains|RTT |
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