大转子延长截骨在股骨柄翻修术中的应用

The application of extended greater trochanteric osteotomy in artificial femoral component revision

目的 报道大转子延长截骨在股骨柄翻修术中的应用及其疗效。方法 从 1998年 1月～ 2000年 1月，采用大转子延长截骨术取出股骨柄、骨水泥，行翻修术 11例。男 7例，女 4例。年龄 53～ 69岁，平均 65.4岁。翻修原因 :股骨柄断裂 2例，人工股骨头置换术后髋臼骨关节炎 8例，假体位置异常 1例。结果 11例患者术后第 2 d均在助行器辅助下下床行走，术后 3个月大转子延长截骨处临床愈合后，改扶单拐行走， 6个月后弃拐行走。术后随访 6～ 30个月，大转子延长截骨处骨性愈合， Harris评分平均为 89.6分。结论 大转子延长截骨术多用于翻修术中取出固定牢固的骨水泥或非骨水泥假体柄。其适应证包括 :(1)股骨柄近端断裂，远端仍牢固固定者； (2)人工股骨头置换术后发生髋臼骨关节炎伴髋关节强直，股骨柄固定牢固，需行全髋翻修者； (3)股骨柄安放位置错误，但骨水泥固定良好者； (4)不伴有假体松动的早期严重感染需行翻修者。该方法显露充分，术后恢复快，是一种较好的股骨柄固定牢固的翻修方法。主要并发症有截骨处不愈合、移位及截骨片骨折。

Objective To study the clinical application of extended greater trochanteric osteotomy in artificial femoral component revision. Methods From January 1998 to January 2000, 11 patients were treated with extended greater trochanteric osteotomy in artificial femoral component revision. Among them, there were 7 males and 4 females, from 53 to 69 years old (average 65.4 years old). For the reasons of revision, there were broken of artificial femoral component in 2 cases, acetabular osteoarthritis after hemiarthroplasty in 8 cases and abnormal position of artificial femoral component in 1 case. During the operation, osteotomy was made at the lateral side of the femur including the greater trochanter and the upper femoral shaft, its width should be less than 1/3 of the diameter of the femur. After osteotomy, the femoral prosthesis and the cement could be taken out easily. Gelatin foam was placed throughout the osteotomy site as a gasket. Then doubled monofilament wires were used to fasten the osteotomy fragment to the femur shaft while the revision prosthesis was inserted into the femoral canal. Results All of the patients could walk with walking aids two days after operation. Six months after operation, the fracture of osteotomy healed and the patients could walk without crutchs. Follow- up period was from 6 months to 30 months, the average score of Harris evaluation was 89.5. Conclusion The extended greater trochanteric osteotomy can be used in artificial femoral component revision. The indication includes:1.Broken of artificial femoral component. 2.Acetabular osteoarthritis after hemiarthroplasty. 3.Customary dislocation of hip joint due to abnormal position of artificial femoral component. 4.Severe infection without loosening of artificial joint. The complications of this operation are nonunion, displacement and fracture of the osteotomy fragment.