Warren P J, Thompson P, Fletcher M D A
The Department of Orthopaedic Surgery, Northwick Park Hospital, Watford Road, Harrow, Middlesex, UK.
Arch Orthop Trauma Surg. 2002 Dec;122(9-10):557-60. doi: 10.1007/s00402-002-0424-5. Epub 2002 Sep 13.
The Wagner SL uncemented revision stem has been utilised successfully for revision hip surgery where marked loss of proximal bone stock co-exists or where there is a periprosthetic fracture. Implanted via the transfemoral approach, one significant difficulty appears to be a tendency for implant subsidence, which in some cases has been troublesome enough to necessitate early revision (usually to a larger prosthesis).
A change in our operative practice allowed us to review the effects of using either wire cerclages or 2.0 mm Dall-Miles cables for prophylactic wiring of the distal femur. Seventeen Wagner SL stems, inserted via the transfemoral approach, were studied in 16 patients.
We found those patients prophylactically wired with Dall-Miles cables demonstrated no subsidence in comparison with those in whom heavy wire cerclage had been utilised (mean subsidence 6 mm; p=0.001). In addition, we found that closure of the proximal osteotomy with wires conferred a more reliable rate of union in comparison with those closed with heavy sutures.
We recommend the use of Dall-Miles cables for distal cerclage and osteotomy closure for the Wagner prosthesis.
瓦格纳SL非骨水泥翻修柄已成功应用于近端骨量显著丢失并存或存在假体周围骨折的髋关节翻修手术。通过经股骨入路植入时，一个显著的困难似乎是植入物有下沉的趋势，在某些情况下，这种下沉严重到需要早期翻修（通常更换为更大的假体）。
我们手术操作的改变使我们能够回顾使用钢丝环扎或2.0毫米Dall-Miles缆线对股骨远端进行预防性钢丝固定的效果。对16例患者中通过经股骨入路植入的17个瓦格纳SL柄进行了研究。
我们发现，与使用粗钢丝环扎的患者相比，采用Dall-Miles缆线进行预防性钢丝固定的患者没有出现下沉（平均下沉6毫米；p=0.001）。此外，我们发现，与使用粗缝线闭合的患者相比，用钢丝闭合近端截骨术的骨愈合率更可靠。
我们建议使用Dall-Miles缆线对瓦格纳假体进行远端环扎和截骨术闭合。
