Khanna Gaurav, Bourgeault Craig A, Kyle Richard F
Orthopaedic Biomechanics Laboratory, Midwest Orthopaedic Research Foundation, 914 South 8th Street, Mail Code 860C, Minneapolis, MN 55404, USA.
Clin Biomech (Bristol). 2007 Jun;22(5):599-602. doi: 10.1016/j.clinbiomech.2006.02.002. Epub 2007 Mar 9.
Depending upon the clinical presentation and need for exposure in revision hip arthroplasty, an extended trochanteric osteotomy or slot osteotomy could be used for removal of an inaccessible distal cement mantle, infected material, or distal fragment of a broken stem. This study is a biomechanical comparison of these two osteotomy techniques.
A press-fit femoral component with a 20-cm straight stem was implanted in each of ten synthetic femurs. The stiffness of these components implanted in the femurs was measured for a compressive load condition simulating the stance phase of level walking. Half of the femurs then received an extended trochanteric osteotomy, and the other half a slot osteotomy. Stiffness testing was repeated both after the osteotomized bone was removed, and after it was fixed back in place by cerclage wiring.
The stiffness of the femoral component/synthetic femur constructs in the slot osteotomy group was significantly greater than in the extended trochanteric osteotomy group.
This study demonstrated that in the laboratory setting, the slot osteotomy was significantly stiffer than the more traditional extended trochanteric osteotomy. However, the clinical implications of this increased stiffness are unknown. The ultimate choice of the type of osteotomy depends upon the exposure requirements for a given clinical situation.
根据髋关节翻修术中的临床表现及暴露需求，可采用大转子延长截骨术或槽形截骨术来移除难以触及的远端骨水泥壳、感染物质或折断柄的远端碎片。本研究对这两种截骨技术进行了生物力学比较。
将带有20厘米直柄的压配型股骨假体植入10个合成股骨中。在模拟平路站立期的压缩负荷条件下，测量这些植入股骨的假体的刚度。然后，一半股骨接受大转子延长截骨术，另一半接受槽形截骨术。在截下的骨头移除后以及通过环扎钢丝固定回原位后，重复进行刚度测试。
槽形截骨术组的股骨假体/合成股骨结构的刚度显著大于大转子延长截骨术组。
本研究表明，在实验室环境中，槽形截骨术比更传统的大转子延长截骨术刚度明显更大。然而，这种刚度增加的临床意义尚不清楚。截骨术类型的最终选择取决于特定临床情况的暴露需求。
