Innocenti Matteo, Leggieri Filippo, Stimolo Davide, Carminati Mattia, Christian Carulli, Civinini Roberto
Department of Orthopaedic Surgery, University of Florence, Florence, Italy.
Ann Jt. 2023 Nov 9;9:20. doi: 10.21037/aoj-23-26. eCollection 2024.
Proximal femoral replacement due to revision hip arthroplasty or catastrophic proximal femur fracture fixation failures with considerable proximal femur bone loss can lead to a substantial loss of function of the soft tissue around the hip and the abductor muscles in particular. Surgical techniques of gluteus medius repair and/or abductor mechanism reattachment/reconstruction are widely debated in the literature, but it is quite rarely dealt with in the context of megaprosthesis and femoral reconstruction, particularly in non-oncologic patients. The aim of this study is to present a narrative review of the literature on techniques for abductor reattachment in proximal femoral replacement for non-oncological reconstructions.
MEDLINE, Embase, and Cochrane databases were searched by two researchers independently from inception until February 1st, 2023 (923 for MEDLINE and 963 for Embase; Cochrane is a composite of multiple databases and thus does not report a standard inception date). Articles examining proximal femoral reconstruction with megaprosthesis or allograft prosthesis were included. Studies concerning cadaver and oncologic patients were excluded. If the researchers failed to find an agreement on whether to include a study, the senior researcher would make a final decision in such cases. Data were extracted and stored, and qualitative synthesis was performed.
A total of 1,157 articles from MEDLINE, 11,187 articles from Embase, and 0 articles from Cochrane were identified. Of 12,344 articles, the structured screening process revealed 10 eligible trials. Four different types of abductor musculature reconstruction/reinsertion were identified.
Multiple and complex revision hip arthroplasties as well as multiple surgical procedures for proximal femur fracture fixations failures may have a great impact on proximal femur bone stock condition and soft tissue preservation requiring the use of a proximal femur megaprosthesis. In such cases, the abductor mechanism reconstruction and/or reattachment is achievable with different techniques that can be resumed in four different groups: direct suture to the prosthesis, trochanteric sleeve osteotomy, muscle-to-muscle suture, and synthetic tube augmentation suture.
因髋关节置换翻修术或近端股骨灾难性骨折内固定失败且伴有大量近端股骨骨质流失而进行的近端股骨置换，可能会导致髋关节周围软组织，尤其是外展肌功能大幅丧失。臀中肌修复和/或外展肌机制重新附着/重建的手术技术在文献中存在广泛争议，但在使用大型假体和股骨重建的背景下却很少涉及，尤其是在非肿瘤患者中。本研究的目的是对非肿瘤重建近端股骨置换中外展肌重新附着技术的文献进行叙述性综述。
两名研究人员独立检索MEDLINE、Embase和Cochrane数据库，检索时间从数据库建立至2023年2月1日（MEDLINE检索到923篇，Embase检索到963篇；Cochrane是多个数据库的组合，因此未报告标准建立日期）。纳入研究使用大型假体或同种异体假体进行近端股骨重建的文章。排除有关尸体和肿瘤患者的研究。如果研究人员在是否纳入某项研究上未能达成一致，由资深研究人员做出最终决定。提取并存储数据，进行定性综合分析。
MEDLINE共识别出1157篇文章，Embase共识别出11187篇文章，Cochrane共识别出0篇文章。在这12344篇文章中，结构化筛选过程显示有10项符合条件的试验。识别出四种不同类型的外展肌重建/重新插入方法。
多次复杂的髋关节置换翻修术以及近端股骨骨折内固定失败的多次手术可能会对近端股骨骨量状况和软组织保存产生重大影响，需要使用近端股骨大型假体。在这种情况下，外展肌机制重建和/或重新附着可以通过不同技术实现，可归纳为四个不同组：直接缝合至假体、转子套截骨术、肌肉对肌肉缝合以及合成管增强缝合。
