Prudhon Jean Louis, Tardy Nicolas
Centre osteo articulaire, 5 rue des tropiques, 38130 Echirolles, France.
SICOT J. 2018;4:21. doi: 10.1051/sicotj/2018017. Epub 2018 Jun 13.
The trans femoral osteotomy was initially described by Wagner in 1987 and the extended trochanteric osteotomy (ETO) was described by Younger et al. in 1995 and is considered to be the gold standard technique for removal of well-fixed femoral stems in revision total hip arthroplasty (THA). The purpose of this report is: to compare the different types of fixation metallic wires, cables, metallic reinforcement plate (MRP) we have used in revision THA where an ETO was performed; analyse the clinical and radiological outcomes of these devices at 1 year; analyse the complication.
It is a retrospective continuous monocentric series of 157 patients where an ETO was performed. It was fixed by an MRP in 17 patients, cables in 43, metallic wires in 97. The main outcome was the consolidation of the osteotomized femoral flap (OFF). Secondary outcomes were Postel Merle d'Aubigne score and complications occurred at 1 year follow up. Qualitative variable was presented as percentage, quantitative variables as mean or median, standard deviation and range.
157 patients (73-46, 5% females) were included. Mean age at surgery was 66.7 year (sd = 10.63). Mean interval between index surgery and revision was 11.07 year (sd = 5.67). Causes for revision and bone defects were comparable. At 1 year OFF is healed without displacement in 82% with metallic wires, 70% with cables, 88% with MRP. Not significant.
Fixation of the femoral flap is a technical issue in ETO. Metallic wires and cables are the most commonly used to secure the fixation. Fixation with a metallic plate is reported in a few number of articles and may be helpful specially when a fracture of the OFF occurred during surgery.
经股骨截骨术最初由瓦格纳于1987年描述，而扩大转子截骨术（ETO）由扬格等人于1995年描述，被认为是翻修全髋关节置换术（THA）中取出固定良好的股骨柄的金标准技术。本报告的目的是：比较我们在进行ETO的翻修THA中使用的不同类型的固定金属丝、缆线、金属加强板（MRP）；分析这些装置在1年时的临床和放射学结果；分析并发症。
这是一项回顾性连续单中心系列研究，共纳入157例行ETO的患者。其中17例用MRP固定，43例用缆线固定，97例用金属丝固定。主要结局是截骨股骨瓣（OFF）的愈合。次要结局是术后1年的Postel Merle d'Aubigne评分和并发症。定性变量以百分比表示，定量变量以均值或中位数、标准差和范围表示。
纳入157例患者（73例男性，46例女性，5%为女性）。手术时的平均年龄为66.7岁（标准差=10.63）。初次手术与翻修之间的平均间隔时间为11.07年（标准差=5.67）。翻修原因和骨缺损情况具有可比性。1年后，使用金属丝固定的患者中82%的OFF愈合且无移位，使用缆线固定的为70%，使用MRP固定的为88%。差异无统计学意义。
股骨瓣的固定是ETO中的一个技术问题。金属丝和缆线是最常用的固定方式。少数文章报道了用金属板固定，特别是在手术过程中OFF发生骨折时可能会有帮助。
