Connault P, Gayet L E, Merienne J F, Pries P, Clarac J P
Service d'orthopédie-traumatologie adulte et infantile du Pr Clarac, Hôpital Jean Bernard C.H.R.U. la Milétrie, Poitiers.
Rev Chir Orthop Reparatrice Appar Mot. 1995;81(1):44-50.
A retrospective study to compare the results obtained in our first 100 total hip prostheses inserted by Hardinge's approach and of the 100 others inserted by trochanterotomy was undertaken.
In the trochanterotomy group the average age was 66 years; average follow-up was 26 months. Using the Merle d'Aubigné score the initial score was 11.8. There were 65 cases of centered hip arthritis. In the Hardinge group the average age was 65 years; average follow-up was 28.3 months. The Merle d'Aubigné initial score was 12.3. There were 78 cases of centered hip arthritis. There were therefore no significant differences between the two groups and the two groups were comparable.
The quantitative variables (age, duration of operation, blood loss, blood transfusion, follow-up) were compared by Student's test. The qualitative variables (thrombo-embolic complications, dislocations, periarticular ossifications, acetabular radiolucency lines, non-union of the greater trochanter, gluteus medius palsies) were compared by the chi 2 test.
We found no significative differences on neither the functional level nor on the orientation of the prostheses nor on the number of infectious complications between these two surgical approaches. Moreover, we found more complications such as thromboembolism and dislocations favoured by non-union of the greater trochanter in patients operated by trochanterotomy. These patients also had greater blood loss. In patients operated by Hardinge's approach, we found gluteus medius palsies (recovering secondarily); we also found a higher frequency of periarticular ossifications and a greater number of partial acetabular lines.
Non-union of the greater trochanter appears in all the series of total hip arthroplasty by trochanterotomy. No technique permitted to avoid this complication which usually leads to pain and hip instability. This surgical approach is associated with higher blood loss. With Hardinge's approach there is no risk of non-union of the greater trochanter and blood loss is less important. The risk of gluteus medius palsy has to be taken in to account but digital dissection of the muscle fibers seems adequate to diminish the frequency of this complication. There is also a greater number of asymptomatic periarticular ossifications in our study but whose long term consequences are unknown.
This study leads us to prefer the Hardinge approach for total hip arthroplasty. Our recent experience encourages us even because it permits osteoplastic ridge and total hip resumption. We use the trochanterotomy only for the most difficult cases specially hip arthritis secondary to severe dysplasia or congenital hip dislocations when a lowering effect of the great trochanter should also be associated.
进行一项回顾性研究，比较采用哈丁格入路植入的首批100例全髋关节假体与采用转子截骨术植入的另外100例全髋关节假体的结果。
在转子截骨术组中，平均年龄为66岁；平均随访时间为26个月。使用默尔·德奥布涅评分，初始评分为11.8。有65例中心性髋关节炎病例。在哈丁格组中，平均年龄为65岁；平均随访时间为28.3个月。默尔·德奥布涅初始评分为12.3。有78例中心性髋关节炎病例。因此，两组之间无显著差异，具有可比性。
通过学生检验比较定量变量（年龄、手术时间、失血量、输血、随访）。通过卡方检验比较定性变量（血栓栓塞并发症、脱位、关节周围骨化、髋臼透亮线、大转子不愈合、臀中肌麻痹）。
我们发现这两种手术方法在功能水平、假体方向或感染并发症数量方面均无显著差异。此外，我们发现转子截骨术患者中，大转子不愈合更容易引发血栓栓塞和脱位等并发症。这些患者的失血量也更多。在采用哈丁格入路手术的患者中，我们发现了臀中肌麻痹（随后恢复）；还发现关节周围骨化的发生率更高，髋臼部分透亮线更多。
在所有采用转子截骨术的全髋关节置换系列中均出现了大转子不愈合。没有技术能够避免这种通常会导致疼痛和髋关节不稳定的并发症。这种手术方法与更高的失血量相关。采用哈丁格入路不存在大转子不愈合的风险，失血量也较少。必须考虑臀中肌麻痹的风险，但对肌肉纤维进行手指分离似乎足以降低这种并发症的发生率。在我们的研究中还发现了更多无症状的关节周围骨化，但其长期后果尚不清楚。
这项研究使我们更倾向于在全髋关节置换术中采用哈丁格入路。我们最近的经验更坚定了这一选择，因为它允许进行骨成形嵴和全髋关节复位。我们仅在最困难的病例中使用转子截骨术。特别是对于继发于严重发育不良或先天性髋关节脱位的髋关节炎，此时大转子的下移效果也应考虑在内。
