Sanchez-Sotelo Joaquin, Gipple John, Berry Daniel, Rowland Charles, Cofield Robert
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Acta Orthop Belg. 2005 Oct;71(5):548-54.
This study evaluates primary hip replacement performed using a modified posterior approach through a limited posterior trochanteric osteotomy bone block that includes the insertions of the posterior capsule and short external rotators--as this may enhance secure reattachment of the posterior soft-tissue envelope and protect against postoperative instability. Sixty-eight consecutive primary hip replacements performed through a posterior trochanteric osteotomy were prospectively followed. Two were lost to follow-up before a minimum of 2 years after the arthroplasty; the remaining 66 hips were followed for a mean of 10 years (range: 2 to 15). The median Harris hip score improved from 43 to 84 points (p < 0.0001). Radiographic union of the osteotomy was confirmed in 64 hips (94%). Two episodes of early dislocation occurred 5 days and 8 months postoperatively; both were successfully managed nonoperatively without continuing instability. There were no cases of late instability. Posterior approach to the hip joint through a posterior trochanteric osteotomy is associated with high union rates and a low rate of late instability after hip replacement.
本研究评估了采用改良后入路，通过有限的转子后截骨骨块进行初次髋关节置换术，该骨块包括后关节囊和短外旋肌的附着点——因为这可能会增强后软组织包膜的牢固重新附着，并防止术后不稳定。对连续68例通过转子后截骨进行的初次髋关节置换术进行了前瞻性随访。2例在关节置换术后至少2年之前失访；其余66髋平均随访10年（范围：2至15年）。Harris髋关节评分中位数从43分提高到84分（p < 0.0001）。64髋（94%）截骨处影像学愈合得到证实。术后5天和8个月发生2次早期脱位；均通过非手术成功处理，未出现持续不稳定。无晚期不稳定病例。通过转子后截骨进行髋关节后入路与髋关节置换术后高愈合率和低晚期不稳定率相关。
