Oe Kenichi, Iida Hirokazu, Kobayashi Fumito, Ueda Narumi, Nakamura Tomohisa, Okamoto Naofumi, Saito Takanori
Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-city, Osaka, 573-1010, Japan.
Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-city, Osaka, 573-1010, Japan.
J Orthop Sci. 2018 Nov;23(6):992-999. doi: 10.1016/j.jos.2018.07.020. Epub 2018 Aug 17.
The optimum approach in total hip arthroplasty (THA) should reduce the risk of postoperative dislocation or limping, be applicable in every case, and be reusable in the future. The purpose of this study was to introduce our transgluteal approach for THA and to evaluate the type and frequency of complications around the greater trochanter.
This study retrospectively evaluated 892 THA cases between January 2010 and March 2015 performed using our transgluteal approach that osteotomized only the lateral anteroinferior greater trochanter. The trochanteric fragment was reattached using one of three different protocols: Group A, three non-absorbable polyester sutures; Group B, two non-absorbable polyester sutures and one ultra-high molecular weight polyethylene (UHMWPE) fiber cable; or Group C, two UHMWPE fiber cables. Postoperative complications were assessed and recorded, and univariate logistic regression analyses were performed to determine whether risk factors and radiological complications around the greater trochanter were correlated.
None of the hips required revision for infection, dislocation, or limping. The rate of radiological complications around the greater trochanter at 1 year was 19.2% in Group A, 16.3% in Group B, and 7.9% in Group C (p < 0.001). Risk factors for radiological complications included the patient's disease or the surgeon's experience in Group A and the patient's age or the surgeon's experience in Group C. In the relationship between postoperative pain around the greater trochanter and radiological complications, there were no significant differences in all groups; no group interaction was observed (p= 0.3875).
The UHMWPE fiber cable was effective to reduce complications of the reattached osteotomized greater trochanter in THA.
全髋关节置换术（THA）的最佳方法应降低术后脱位或跛行的风险，适用于所有病例，并可在未来重复使用。本研究的目的是介绍我们用于THA的经臀肌入路，并评估大转子周围并发症的类型和发生率。
本研究回顾性评估了2010年1月至2015年3月间采用我们的经臀肌入路进行的892例THA病例，该入路仅对大转子前外侧下部分进行截骨。使用三种不同方案之一重新固定转子碎片：A组，三根不可吸收聚酯缝线；B组，两根不可吸收聚酯缝线和一根超高分子量聚乙烯（UHMWPE）纤维缆线；或C组，两根UHMWPE纤维缆线。评估并记录术后并发症，并进行单因素逻辑回归分析以确定大转子周围的危险因素与放射学并发症是否相关。
所有髋关节均无需因感染、脱位或跛行而翻修。1年时大转子周围放射学并发症的发生率在A组为19.2%，B组为16.3%，C组为7.9%（p<0.001）。放射学并发症的危险因素在A组包括患者疾病或外科医生经验，在C组包括患者年龄或外科医生经验。在大转子周围术后疼痛与放射学并发症的关系中，所有组均无显著差异；未观察到组间交互作用（p=0.3875）。
UHMWPE纤维缆线可有效减少THA中重新固定的截骨大转子的并发症。
