Fehrle M J, Callaghan J J, Clark C R, Peterson K K
University of Iowa College of Medicine, Department of Orthopaedics, Iowa City.
J Arthroplasty. 1993 Feb;8(1):1-6. doi: 10.1016/s0883-5403(06)80101-4.
Tibial strut bone grafting and more recently fibular strut grating (vascularized) have been used in the treatment of aseptic necrosis of the femoral head. The authors evaluated the technical aspects and results of uncemented total hip arthroplasty after previous tibial bone grafting of the femoral head in patients with aseptic necrosis. Review of postoperative radiographs demonstrated that residual tibial graft prevented optimal femoral canal fit and positioning of the prosthetic stem in 10 of 13 hips (in the coronal plane). In the nine hips with a minimum 2-year follow-up period, two required revision for loosening of the femoral component. The authors recommend that, when performing an uncemented total hip arthroplasty in patients with previous strut grafting, special attention be directed to adequate graft removal, particularly in the lateral greater trochanteric fossa to prevent varus placement of the femoral component. An intraoperative anteroposterior radiograph with the final femoral broach in place may be useful in verifying adequate strut graft removal and optimal canal fill with proper prosthesis positioning.
胫骨支撑骨移植以及最近的腓骨支撑移植（带血管）已被用于治疗股骨头无菌性坏死。作者评估了在无菌性坏死患者中，先前对股骨头进行胫骨骨移植后，非骨水泥型全髋关节置换术的技术要点及结果。术后X线片复查显示，在13髋中的10髋（在冠状面），残留的胫骨移植骨妨碍了股骨假体柄与股骨髓腔的最佳匹配及定位。在随访至少2年的9髋中，有2髋因股骨部件松动而需要翻修。作者建议，对于先前接受过支撑移植的患者进行非骨水泥型全髋关节置换术时，应特别注意充分去除移植骨，尤其是在大转子外侧窝，以防止股骨部件内翻位放置。术中放置最终股骨扩髓器后的前后位X线片，可能有助于验证支撑移植骨是否充分去除以及假体是否正确定位并实现髓腔的最佳填充。
