Kelley S S, Johnston R C
University of North Carolina, Chapel Hill 27599-7055.
Clin Orthop Relat Res. 1992 Dec(285):140-6.
To address the issue of nonunion with trochanteric osteotomy, surgeons have experimented with various modes of fixation, wire and cable being the two most popular. From a group of 643 primary cemented total hip arthroplasties performed by a single surgeon via the trans-trochanteric approach, minimum four-year roentgenographic follow-up evaluations were performed on 322 hips (50%). The method of fixation was stainless steel monofilament wire in 162 cases and Co-Cr cable in 160. Trochanteric union rates were 75% (122 patients) for the wire group and 79% (126 patients) for the cable. Breakage rates of the entire trochanteric fixation construction (all three wires or cables) were 43% (68 patients) for the wire and 12% (20 patients) for the cable. Unraveled cable was seen in 56% of the hips (90 patients), and in 47% of these hips, there were no broken cables. Blinded roentgenographic analysis of the acetabulum, preformed independently, revealed that loosening of the acetabulum in the cable group was greater than in the wire group. Cables offer no significant benefit over wires and may have potential adverse effects. Generation of significant particulate debris was noted roentgenographically, and marked reaction/destruction was found at the time of revision surgery.
为解决转子截骨术后不愈合的问题，外科医生尝试了各种固定方式，其中钢丝和缆线是最常用的两种。在一位外科医生采用经转子入路进行的643例初次骨水泥型全髋关节置换术中，对322髋（50%）进行了至少四年的X线随访评估。固定方法为162例使用不锈钢单丝钢丝，160例使用钴铬合金缆线。钢丝组转子愈合率为75%（122例患者），缆线组为79%（126例患者）。整个转子固定结构（三根钢丝或缆线全部）的断裂率，钢丝组为43%（68例患者），缆线组为12%（20例患者）。56%的髋（90例患者）出现缆线松解，其中47%的髋没有缆线断裂。独立进行的髋臼X线盲法分析显示，缆线组髋臼松动程度大于钢丝组。与钢丝相比，缆线没有显著优势，且可能存在潜在不良影响。X线检查发现产生了大量颗粒碎片，翻修手术时发现有明显的反应/破坏。
