Bal B S, Maurer B T, Harris W H
Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston 02114, USA.
J Arthroplasty. 1998 Jan;13(1):29-33. doi: 10.1016/s0883-5403(98)90072-9.
Ninety-nine patients (106 hips) with a trochanteric osteotomy during revision total hip arthroplasty were evaluated at a minimum of 5 years after surgery. Trochanteric reattachment was done with monofilament cobalt-chromium wires. The influence of the following variables on trochanteric union was examined: a prior trochanteric osteotomy, an existing trochanteric nonunion, trochanteric advancement to the lateral femur, use of vertical (in addition to horizontal) wires through the trochanter, and use of a trochanteric mesh. Overall, union occurred in 92 of the 106 trochanters (87%). Fifty-three of 61 trochanters (86.9%) healed after an initial osteotomy, whereas 34 of 38 (89.5%) healed after a repeat osteotomy. Five of the 7 trochanters with an existing nonunion healed, and 5 of 5 trochanters reattached to a bulk allograft healed. Twenty-nine of 36 trochanters (80.5%) reattached to cancellous bone healed, compared with 58 of 65 (89.2%) that were reattached to the lateral femoral cortex. Ninety percent (83/92) of the trochanters reattached in conjunction with use of a chrome-cobalt mesh healed, compared with 64.3% (9/14) of those without (P < .05). Of the variables studied, only the use of mesh was statistically significant. Osteotomy through a previously healed trochanter, advancement of the trochanter to cortical bone, existing trochanteric nonunion, trochanteric reattachment to a bulk allograft, and lack of vertical wires for fixation did not adversely affect the likelihood of obtaining trochanteric union.
对99例（106髋）在翻修全髋关节置换术中进行转子截骨的患者进行了术后至少5年的评估。转子重新附着采用单丝钴铬合金钢丝完成。研究了以下变量对转子愈合的影响：既往转子截骨、现有的转子不愈合、转子向股骨外侧移位、通过转子使用垂直（除水平外）钢丝以及使用转子网。总体而言，106个转子中有92个（87%）实现了愈合。61个转子中的53个（86.9%）在初次截骨后愈合，而38个中的34个（89.5%）在再次截骨后愈合。7个存在不愈合的转子中有5个愈合，5个重新附着于大块同种异体骨的转子全部愈合。重新附着于松质骨的36个转子中有29个（80.5%）愈合，而重新附着于股骨外侧皮质的65个中有58个（89.2%）愈合。使用铬钴合金网重新附着的转子中有90%（83/92）愈合，未使用的为64.3%（9/14）（P<0.05）。在所研究的变量中，只有网的使用具有统计学意义。通过先前已愈合的转子进行截骨、转子向皮质骨移位、现有的转子不愈合、转子重新附着于大块同种异体骨以及缺乏垂直固定钢丝均未对获得转子愈合的可能性产生不利影响。
