Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
J Arthroplasty. 2019 Jul;34(7):1470-1475. doi: 10.1016/j.arth.2019.02.054. Epub 2019 Mar 1.
The effect of extended trochanteric osteotomy (ETO) with immediate cerclage wire fixation on the scene of chronic periprosthetic joint infection on infection eradication and the osteotomy healing remains unclear.
One hundred seventeen patients who underwent two-stage revision total hip arthroplasty for chronic periprosthetic joint infection were enrolled in the study. The minimum follow-up was 2 years. Of these, 48 patients had underwent ETO and immediate cerclage wire fixation during the first-stage surgery, while 69 did not undergo ETO or any other osteotomy. In addition, 18 patients had underwent ETO in the second-stage reimplantation surgery. Repeated debridement, curative rate of infection, and complications were compared between the 2 groups. Meanwhile, osteotomy healing between the first and second osteotomy were also compared.
The repeated debridement rate and curative rate of infection were 2.1% and 95.8% in the ETO group, compared with 13.0% and 82.6% in the non-ETO group; there were significant difference between the 2 groups in these parameters (P = .037 and .030, respectively). Meanwhile, osteotomy healing rate was 93.8% in first-stage surgery with infection scene and 100% in second-stage surgery without infection; no significant difference was detected in osteotomy healing rate and time to healing (P = .278 and .803, respectively). The rate of complication was similar in both groups.
ETO combined with immediate cerclage wire fixation does not appear to reduce the rate of infection eradication. There was no harmful effect on complication rate and osteotomy healing.
带线环扎即刻固定的扩大型转子下截骨术（ETO）对慢性假体周围关节感染病灶在感染清除和截骨愈合方面的效果尚不清楚。
本研究纳入了 117 例接受二期翻修全髋关节置换术治疗慢性假体周围关节感染的患者，随访时间至少 2 年。其中 48 例患者在一期手术中接受了 ETO 及即刻带线环扎固定，69 例患者未行 ETO 或任何其他截骨术。此外，18 例患者在二期再植入手术中接受了 ETO。比较了两组之间的重复清创率、感染治愈率和并发症发生率。同时，还比较了第一次和第二次截骨之间的愈合情况。
ETO 组的重复清创率和感染治愈率分别为 2.1%和 95.8%，而非 ETO 组分别为 13.0%和 82.6%，两组间差异有统计学意义（P=0.037 和 0.030）。此外，在感染病灶一期手术中，截骨愈合率为 93.8%，二期手术无感染时为 100%，两组间截骨愈合率和愈合时间无显著差异（P=0.278 和 0.803）。两组并发症发生率相似。
ETO 联合即刻带线环扎固定似乎并不能降低感染清除率。对并发症发生率和截骨愈合没有不良影响。
