Department of Orthopaedic Surgery, Rush University Medical Center, 1725 West Harrison, Suite 1063, Chicago, IL 60612, USA.
Clin Orthop Relat Res. 2010 Sep;468(9):2382-6. doi: 10.1007/s11999-010-1284-x.
Metallic wires and cables are commonly used in primary and revision THA for fixation of periprosthetic fractures and osteotomies of the greater trochanter. These systems provide secure fixation and high healing rates but fraying, third-body generation, accelerated wear of the bearing surface, and injury to the surgical team remain concerning.
QUESTIONS/PURPOSES: We determined the rate of cable failure, union, and complications associated with a novel, nonmetallic cerclage cable in periprosthetic fracture and osteotomy fixation during THA.
We retrospectively reviewed 29 patients who had primary and revision THAs using nonmetallic cables. Indications for use included fixation of an extended trochanteric osteotomy, intraoperative fracture of the proximal femur, strut allograft fixation, and a Vancouver B1 periprosthetic fracture of the femur. All patients were evaluated clinically and radiographically immediately postoperatively, at 3 weeks, 6 weeks, 3 months, and then annually thereafter. The minimum followup was 13 months (mean, 21 months; range, 13-30 months).
Two of the 29 patients (7%) developed a nonunion; all remaining osteotomies, fractures and allografts had healed at the time of most recent evaluation. Four patients (14%) dislocated postoperatively; two were treated successfully with closed reduction, while the other two required reoperation. We identified no evidence of breakage or other complications directly attributable to the cables.
The nonmetallic periprosthetic cables used in this series provided adequate fixation to allow for both osteotomy and fracture healing. We did not observe any complications directly related to the cables. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
金属丝和电缆常用于初次和翻修全髋关节置换术（THA）中，以固定假体周围骨折和大转子截骨术。这些系统提供了可靠的固定和高愈合率，但磨损、第三体生成、轴承表面的加速磨损以及对手术团队的损伤仍然令人担忧。
问题/目的：我们确定了一种新型非金属环形电缆在初次和翻修 THA 中用于假体周围骨折和截骨固定时的电缆失效、愈合和并发症的发生率。
我们回顾性分析了 29 例使用非金属电缆的初次和翻修 THA 患者。使用指征包括：延长转子截骨术固定、术中股骨近端骨折、支撑同种异体骨固定和股骨假体周围 B1 型骨折。所有患者均在术后即刻、3 周、6 周、3 个月以及此后每年进行临床和影像学评估。随访时间至少为 13 个月（平均随访 21 个月；范围为 13-30 个月）。
29 例患者中有 2 例（7%）发生了不愈合；所有其余截骨术、骨折和同种异体骨均在最近一次评估时愈合。4 例（14%）患者术后脱位；其中 2 例经闭合复位成功治疗，另 2 例需要再次手术。我们没有发现任何直接归因于电缆的断裂或其他并发症的证据。
本系列中使用的非金属假体周围电缆提供了足够的固定，以允许截骨术和骨折愈合。我们没有观察到任何与电缆直接相关的并发症。证据水平为 IV 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
