Amstutz H C, Mai L L, Schmidt I
Clin Orthop Relat Res. 1984 Mar(183):82-9.
In 3.2% of 712 procedures performed in 668 hips after May 1, 1976, separation and migration of the trochanteric fragment occurred after total hip arthroplasty (THA) through a transtrochanteric approach and an interlocking cruciate two-wire technique of reattachment. Of these hips, 23 trochanters showed separation, and in eight the Trendelenburg test was positive. The abductor weakness was correlated with the amount of separation, especially if it exceeded 2 cm. Trochanteric separation was attributed to technical deficiencies, including a small trochanteric fragment, wire placed around the lesser trochanter, and/or a loose wire loop. Improved technique reduced the separation and migration rate from 4.5% to 2.3% following primary surgery. Trochanteric advancement with impaction against the vastus ridge and repair of the vastus lateralis were major determinants in reducing the migration rate of those that did not unite and were responsible for improved gait in this second series. However, the failure rate remained at 7% following reoperations for failed THA. As a result, a more secure three-wire technique with two vertical wires has been used in 36 revision operations since July 1981 with no incidence of migration.
1976年5月1日之后，在668例髋关节上进行的712例手术中，有3.2%的病例在采用经转子入路和交锁十字双钢丝重新固定技术进行全髋关节置换术（THA）后，转子碎片出现分离和移位。在这些髋关节中，23个转子出现分离，其中8例Trendelenburg试验呈阳性。外展肌无力与分离程度相关，尤其是当分离超过2厘米时。转子分离归因于技术缺陷，包括转子碎片小、钢丝环绕小转子放置以及/或者钢丝环松动。改进技术后，初次手术后的分离和移位率从4.5%降至2.3%。转子推进并撞击股嵴以及修复股外侧肌是降低未愈合病例移位率的主要决定因素，也是本第二组病例步态改善的原因。然而，在因THA失败而进行的再次手术中，失败率仍为7%。因此，自1981年7月以来，在36例翻修手术中采用了更可靠的带有两根垂直钢丝的三线技术，未发生移位情况。
