Fink Bernd
Klinik für Endoprothetik, Allgemeine und Rheumaorthopädie, Orthopädische Klinik Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Germany.
Orthopaedic Department, University-Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
J Clin Orthop Trauma. 2020 Jan-Feb;11(1):33-37. doi: 10.1016/j.jcot.2019.11.001. Epub 2019 Nov 9.
For the removal of well fixed femoral stems, various standard and extended approaches are possible, all of which have their advantages and disadvantages. They should allow good visualization and avoid uncontrolled damage to the bone (especially devascularization and fractures) and to the musculature (especially the gluteus medius). As an extended approach we prefer the transfemoral approach in a modified Wagner technique. It is indicated for the controlled removal of broken endoprosthetic stems, a significantly thinned bone at risk of fracture, a stable cement mantle, a partially fixed cementless prosthetic stem with a coarse, rough surface, and infected, fixed total hip endoprostheses. In this review article we describe our experience with our technique of the transfemoral approach.
In 68 patients with hip revisions using the modified transfemoral approach, the Harris Hip Score increased continuously from 41.4 points preoperatively to 85.9 points 24 months postoperatively. The bony flap showed bone consolidation in 98.5% of cases. In 76 patients with transfemoral two-stage septic hip revisions, with closure of the flap around the interim prosthesis with cerclage wires and reopening of the flap during second stage revision, the Harris Hip Score was 62.2 ± 12.6 points before the replacement of the spacer and 86.6 ± 15.5 points two years after reimplantation. The healing rate of the bony flap after reimplantation was 98.7%, the absence of infection 93.4%, the rate of stem subsidence 6.6%, and the dislocation rate 6.6%; there was no aseptic loosening of the implants.
The transfemoral approach allows a reliable protection of the gluteus medius and the vastogluteal sling, and enables reproducibly good clinical outcomes.
对于取出固定良好的股骨柄，有多种标准和扩展入路可供选择，所有这些入路都有其优缺点。它们应能提供良好的视野，并避免对骨骼（尤其是血管损伤和骨折）和肌肉组织（尤其是臀中肌）造成失控性损伤。作为一种扩展入路，我们更倾向于采用改良瓦格纳技术的经股骨入路。它适用于控制性取出断裂的内置假体柄、有骨折风险的明显变薄的骨骼、稳定的骨水泥壳、表面粗糙的部分固定非骨水泥假体柄以及感染的、固定的全髋关节假体。在这篇综述文章中，我们描述了我们采用经股骨入路技术的经验。
在68例采用改良经股骨入路进行髋关节翻修的患者中，Harris髋关节评分从术前的41.4分持续提高到术后24个月的85.9分。骨瓣在98.5%的病例中显示骨愈合。在76例采用经股骨两阶段感染性髋关节翻修的患者中，在临时假体周围用环扎钢丝闭合皮瓣，并在第二阶段翻修时重新打开皮瓣，在更换间隔器前Harris髋关节评分为62.2±12.6分，重新植入两年后为86.6±15.5分。重新植入后骨瓣的愈合率为98.7%，无感染率为93.4%，柄下沉率为6.6%，脱位率为6.6%；植入物无无菌性松动。
经股骨入路能够可靠地保护臀中肌和臀大肌吊带，并能持续产生良好的临床效果。
