Barrack Robert L, Butler R Allen
Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, MO 63110, USA.
Clin Orthop Relat Res. 2005 Dec;441:237-42. doi: 10.1097/01.blo.0000191274.42410.40.
A study was done to determine if cable fixation devices of more recent design were associated with a higher success rate and lower incidence of complications compared with early cable devices. Beginning in 1997 a cable plate device was used in an attempt to restore abductor function more consistently in complex total hip arthroplasties. Cobalt-chrome cables through holes in a trochanteric cable plate with two or more transversely oriented cables at or below the lesser trochanter were used in order to resist migration of the trochanteric fragment better. Other component features included instrumentation that allowed provisional fixation and measurement of the tension in the cables so that cables could be tightened and retightened sequentially to insure a minimum of 80 inch-pounds of tension in all cables before final crimping. Minimum 2-year followup was obtained in 42 patients who had complex arthroplasties (trochanteric nonunions and reattachment to structural grafts) in which such a device was used. Clinical and radiographic results were compared with a series of patients with similar indications in whom wire or and earlier-generation trochanteric cable fixation devices were used. The cable plate of a more recent design was associated with a possible trend for a lower incidence of limp, use of assistive walking devices, dislocation, and abductor weakness and significant decrease in the incidence of breakage and trochanteric nonunion.
Therapeutic study, Level III-1 (retrospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.
进行了一项研究，以确定与早期缆线固定装置相比，设计更新的缆线固定装置是否具有更高的成功率和更低的并发症发生率。从1997年开始，一种缆线钢板装置被用于在复杂全髋关节置换术中更持续地恢复外展肌功能。使用钴铬合金缆线穿过转子缆线钢板上的孔，并在小转子处或其下方设置两根或更多根横向缆线，以便更好地抵抗转子碎片的移位。其他部件特点包括可进行临时固定和测量缆线张力的器械，这样缆线可以依次收紧和再收紧，以确保在最终压接前所有缆线的张力至少为80英寸磅。对42例使用了这种装置的复杂关节置换术（转子不愈合和重新附着于结构性移植物）患者进行了至少2年的随访。将临床和影像学结果与一系列具有相似指征且使用钢丝或早期一代转子缆线固定装置的患者进行了比较。设计更新的缆线钢板与跛行、使用辅助行走装置、脱位和外展肌无力发生率可能降低的趋势相关，且断裂和转子不愈合的发生率显著降低。
治疗性研究，III-1级（回顾性比较研究）。有关证据水平的完整描述，请参阅作者指南。
