Langlais F, Lambotte J C, Collin Ph, Langlois F, Fontaine J W, Thomazeau H
Orthopaedic Department, University Hospital Sud, Rennes, France.
J Bone Joint Surg Br. 2003 May;85(4):510-6. doi: 10.1302/0301-620x.85b4.13301.
We used a trochanteric slide osteotomy (TSO) in 94 consecutive revision total hip arthroplasties (90 with replacement of both the cup and stem). This technique proved to be adequate for removing the components, with few complications (two minor fractures), and for implanting acetabular allografts (18%) and reinforcement devices (23%). Trochanteric union was obtained in most patients (96%), even in those with septic loosening (18/19), major femoral osteolysis (32/32), or previous trochanteric osteotomy (17/18). TSO is versatile, since it can be extended by a femoral flap (four cases) or a distal femoral window (eight cases). Despite significant bone loss, in 24% of the femora and 57% of the acetabula, favourable midterm results were achieved and only six reoperations were required, Including two for trochanteric nonunion and two for loosening. It leaves the lateral femoral cortex intact so that a stem longer than 200 mm was needed in only 25% of patients. This is a considerable advantage compared with the extended trochanteric osteotomy in which the long lateral flap (12 to 14 cm) requires an average length of stem of 220 mm beyond the calcar. TSO provides an approach similar in size to the standard trochanteric osteotomy but with a rate of nonunion of 4% versus 15%. It reduces the risk of difficulties with removal of the stem, and removes the need for routine distal anchoring of long revision stems. The limited distal femoral compromise is very important in patients with a long life expectancy.
我们对连续94例全髋关节置换翻修术（其中90例同时置换髋臼杯和股骨柄）采用了转子下滑动截骨术（TSO）。该技术被证明足以取出假体组件，并发症较少（2例轻微骨折），且适用于植入髋臼异体骨（18%）和加强装置（23%）。大多数患者（96%）实现了转子愈合，即使是那些存在感染性松动（18/19）、严重股骨骨溶解（32/32）或既往有转子截骨术（17/18）的患者。TSO具有通用性，因为它可以通过股骨瓣（4例）或股骨远端开窗（8例）进行扩展。尽管存在明显的骨质流失，但在24%的股骨和57%的髋臼中，获得了良好的中期结果，仅需6次再次手术，其中2次是因为转子不愈合，2次是因为松动。它使股骨外侧皮质保持完整，因此仅25%的患者需要长度超过200 mm的股骨柄。与延长转子截骨术相比，这是一个相当大的优势，在延长转子截骨术中，长外侧皮瓣（12至14 cm）需要平均长度超过小转子220 mm的股骨柄。TSO提供了一种与标准转子截骨术大小相似的入路，但不愈合率为4%，而标准转子截骨术为15%。它降低了取出股骨柄困难的风险，并且无需对长翻修股骨柄进行常规远端固定。对于预期寿命较长的患者，有限的股骨远端损伤非常重要。
