Schneeberger A G, Murphy S B, Ganz R
Orthopädische Universitätsklinik Bern, Bern, Switzerland.
Oper Orthop Traumatol. 1997 Mar;9(1):1-15. doi: 10.1007/s00064-006-0001-0.
Easy access to the posterior, superior and anterior joint capsule through an osteotomy which reduces the risk of complications and the incidence of non-union.
Hip joint revision with or without intertrochanteric osteotomy, periarticular ossifications, difficult total hip procedures, exchange procedures.
Absolute: None Relative: Distal transfer of the trochanter.
Radiographs in 2 planes (anterior-posterior pelvis+"false profile" hip).
Lateral decubitus. General anaesthesia.
In lateral decubitus the greater trochanter will be osteotomized from posterior leaving a 1 to 1.5 cm thick bony wafer uniting the insertion of the gluteus medius and minimus with the origin of the vastus lateralis. The trochanteric crest remains untouched. After refixation with nonresorbable sutures #3 the fragment is not subjected to a unidirectional tension by the abductors which could interfere with the consolidation.
Bed rest with lower limb in neutral position. Mobilization with 2 canes on the 2nd postoperative day. The timing of partial weight bearing depends on the type of surgery. Abductor exercises after 6 weeks.
Bony wafer too thin or too thick. Inadequate refixation. Delayed consolidation. Cranial migration of the greater trochanter.
Between 1991 and 1994 41 patients were operated. Diagnoses, see Table 1. Method of refixation: see Table 2. After 21+/-9 months 39 patients could be reexamined clinically, and radiological after 17+/-11 months: 38 osteotomies consolidated. Cranial migration varied between 0 and 8 mm. 25 patients were free of symptoms, 12 had slight and 2 moderate pain over the trochanter. Avulsion of wire cerclage: 2, foreign body irritation: 2 necessitating implant removal.
通过截骨术轻松进入髋关节后方、上方和前方关节囊，降低并发症风险和骨不连发生率。
伴有或不伴有转子间截骨术的髋关节翻修术、关节周围骨化、困难的全髋关节手术、置换手术。
绝对禁忌症：无 相对禁忌症：转子远端转移。
拍摄两个平面的X线片（骨盆前后位 + “假斜位”髋关节）。
侧卧位。全身麻醉。
在侧卧位时，从后方将大转子截骨，保留一块1至1.5厘米厚的骨片，该骨片连接臀中肌和臀小肌的附着点与股外侧肌的起点。转子嵴保持不动。用不可吸收缝线#3重新固定后，骨块不会受到外展肌的单向拉力影响，这可能会干扰骨愈合。
下肢保持中立位卧床休息。术后第二天用双拐辅助活动。部分负重的时间取决于手术类型。6周后进行外展肌锻炼。
骨片过薄或过厚。重新固定不充分。骨愈合延迟。大转子向上移位。
1991年至1994年期间，41例患者接受了手术。诊断结果见表1。重新固定方法见表2。术后21±9个月，39例患者接受了临床复查，术后17±11个月进行了影像学复查：38例截骨处愈合。向上移位在0至8毫米之间。25例患者无症状，12例患者转子处有轻微疼痛，2例患者有中度疼痛。钢丝环扎撕脱：2例，异物刺激：2例，需要取出植入物。
