Wang Jun-Wen, Chen Liang-Kuang, Chen Chin-En
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Kaohsiung, 123, Ta Pei Road, Niao Sung Hsiang, Kaohsiung, Taiwan, Republic of China.
J Bone Joint Surg Am. 2006 Sep;88 Suppl 1 Pt 2:250-8. doi: 10.2106/JBJS.F.00137.
A fracture of the greater trochanter through an osteolytic lesion may occur as a late complication after total hip arthroplasty. The optimal treatment for this difficult complication remains controversial. We have treated this problem with internal fixation and allogeneic bone-grafting at the time of revision of a loose acetabular component.
We retrospectively reviewed the results of treatment of a fracture through an osteolytic lesion of the greater trochanter in nineteen patients seen from 1996 to 2002. All fractures were treated with morselized allogeneic bone grafts and wire fixation at the time of revision of a failed acetabular component. Postoperative care included the use of an abduction orthosis and protected weight-bearing for at least three months. Follow-up of all patients consisted of radiographic examinations and clinical evaluation with use of the Harris hip score.
At an average duration of 3.8 years after the revision, eighteen of the nineteen fractures had healed. The average time to healing was five months. The one treatment failure occurred in a patient who did not comply with the use of an abduction orthosis. The average Harris hip score for all patients improved from 32.5 points preoperatively to 91.2 points at the time of the latest follow-up. Polyethylene wear and recurrent osteolysis of the greater trochanter was noted in one hip at the eight-year follow-up examination.
Fractures of the greater trochanter associated with osteolytic lesions can be effectively treated with open reduction, internal fixation with wire, and allogeneic bone-grafting.
通过溶骨性病变导致的大转子骨折可能作为全髋关节置换术后的晚期并发症出现。对于这种棘手的并发症，最佳治疗方法仍存在争议。我们在翻修松动的髋臼假体时采用内固定和同种异体骨移植来处理这个问题。
我们回顾性分析了1996年至2002年间收治的19例因大转子溶骨性病变导致骨折患者的治疗结果。所有骨折均在翻修失败的髋臼假体时采用异体碎骨移植和钢丝固定治疗。术后护理包括使用外展矫形器并至少三个月保护性负重。所有患者的随访包括影像学检查和使用Harris髋关节评分进行临床评估。
翻修术后平均3.8年时，19例骨折中有18例愈合。平均愈合时间为五个月。一例治疗失败发生在一名未遵医嘱使用外展矫形器的患者身上。所有患者的Harris髋关节评分平均从术前的32.5分提高到最近一次随访时的91.2分。在八年随访检查时，一侧髋关节发现聚乙烯磨损和大转子复发性骨溶解。
与溶骨性病变相关的大转子骨折可通过切开复位、钢丝内固定和同种异体骨移植有效治疗。
