Koyama K, Higuchi F, Kubo M, Okawa T, Inoue A
Department Orthopaedic Surgery, Kurume University School of Medicine, Fukuoka, Japan.
J Orthop Sci. 2001;6(1):22-7. doi: 10.1007/s007760170020.
Clinical and radiographic results of trochanteric osteotomy after revision hip arthroplasty in 62 hips were reviewed. The osteotomized fragment had been reattached using the Dall-Miles cable grip system in each hip. The patients' average age at operation was 64.4 years (range, 40-86 years). The average duration of follow-up was 30.0 months (range. 12-60 months). Trochanteric nonunion was found in 19 hips (30.6%). Trochanteric nonunion developed in 14 (38.9%) of 36 hips with each cable attached around the medial cortex bone, in 2 (16.7%) of 12 hips with each cable passed in a drill hole, and in 3 (21.4%) of 14 hips with one cable passed through a hole and the other attached around the medial cortex. Fragmentation developed in 18 hips (29.0%). In 3 of these 18, the fragments had migrated close to the acetabular component. Cable breakage was seen in 4 hips (6.5%), and bone absorption around the cable in the medial cortex was seen in 17 hips (27.4%). There were 16 hips (25.8%) that presented symptoms at the greater trochanter, including spontaneous pain and tenderness. When the Dall Miles cable grip device is used for reattachment of the greater trochanter, attention should be paid to the condition of the trochanteric bed, the tension of the abductor muscles, and to the placement of the cables and the H-shaped grip.
回顾了62例髋关节翻修术后转子截骨术的临床和影像学结果。在每例髋关节中，均使用Dall-Miles缆线固定系统重新连接截骨碎片。患者手术时的平均年龄为64.4岁（范围40 - 86岁）。平均随访时间为30.0个月（范围12 - 60个月）。19例（30.6%）出现转子不愈合。在36例缆线环绕内侧皮质骨固定的髋关节中，14例（38.9%）发生转子不愈合；在12例缆线穿过钻孔的髋关节中，2例（16.7%）发生转子不愈合；在14例一根缆线穿过钻孔而另一根环绕内侧皮质骨固定的髋关节中，3例（21.4%）发生转子不愈合。18例（29.0%）出现碎片形成。在这18例中的3例中，碎片迁移至髋臼假体附近。4例（6.5%）出现缆线断裂，17例（27.4%）在内侧皮质骨处可见缆线周围的骨质吸收。有16例（25.8%）在大转子处出现症状，包括自发疼痛和压痛。当使用Dall Miles缆线固定装置重新连接大转子时，应注意转子床的情况、外展肌的张力以及缆线和H形固定器的放置。
