Tetreault Allison K, McGrory Brian J
Maine Joint Replacement Institute, Portland, ME, USA; Tufts University School of Medicine, Boston, MA, USA.
Arthroplast Today. 2016 Oct 13;2(4):187-192. doi: 10.1016/j.artd.2016.09.006. eCollection 2016 Dec.
Fixation of the greater trochanter with total hip replacement is challenging and associated with short- and long-term complications. Locking plate technology has been used for fixation of other bones and may be applied successfully in trochanteric fixation. The purpose of this retrospective study was to analyze the utility of the use of trochanteric locking plates in total hip arthroplasty (THA) patients.
From 2004 to 2014, 32 procedures were performed to fix the greater trochanter in patients with trochanteric fracture, osteotomy, or nonunion in the setting of THA. The median age at the time of surgery was 69 years. This was a primary arthroplasty in 8 of the patients, conversion from prior hip surgery in 5, and a revision in 19. The greater trochanter was fixed with locking plate alone in 15 hips and with the addition of a single cerclage cable in 17 hips. Patients were followed clinically and radiographically until healing occurred. The median duration of radiographic follow-up was 41.6 months (range: 10-112 months).
Osseous union occurred in 29 (90.6%) of 32 hips. The median Harris hip score was 94 (range 54-100, standard deviation = 10.4) at latest follow-up. Complications included broken hardware in 5 (15.6%) patients, of which 3 underwent subsequent hardware removal. Two additional patients elected hardware removal due to trochanteric pain.
Locking plate technology is a successful method of fixation of the greater trochanter in patients with THA. Postoperative trochanteric pain and reoperation for hardware-related issues remain a challenge.
全髋关节置换术中大转子的固定具有挑战性，且与短期和长期并发症相关。锁定钢板技术已用于其他骨骼的固定，并可能成功应用于转子固定。本回顾性研究的目的是分析在全髋关节置换术（THA）患者中使用转子锁定钢板的效用。
2004年至2014年，对32例因转子骨折、截骨或THA时不愈合而进行大转子固定的患者进行了手术。手术时的中位年龄为69岁。其中8例患者为初次关节置换，5例为先前髋关节手术的转换，19例为翻修手术。15髋单独使用锁定钢板固定大转子，17髋加用单根环扎钢丝。对患者进行临床和影像学随访，直至愈合。影像学随访的中位持续时间为41.6个月（范围：10 - 112个月）。
32髋中有29髋（90.6%）发生骨愈合。最新随访时Harris髋关节评分的中位数为94分（范围54 - 100分，标准差 = 10.4）。并发症包括5例（15.6%）患者的内固定物断裂，其中3例随后取出了内固定物。另外2例患者因转子疼痛选择取出内固定物。
锁定钢板技术是THA患者大转子固定的一种成功方法。术后转子疼痛和因内固定相关问题再次手术仍然是一个挑战。
