全髋关节翻修术中大转子粉碎性骨折或截骨不愈合的治疗

目的 探讨在全髋关节翻修术中采用张力带方法治疗大转子粉碎性骨折或截骨不愈便的临床效果。方法 1992年1月～1998年10月，对295例行全髋关节翻修术中大转子粉碎性骨折或截骨不愈合的19例(20髋)患者进行治疗，男7例．女12例；年龄63～76岁，平均69岁。20髋中，16髋为假体松动伴骨溶解在翻修术中发生股骨大转子骨折，4髋为全髋关节置换时采用股骨转子截骨入路。因转子截骨不愈合致髋外展肌力不足而行翻修术。采用多枚克氏针加张力带钢丝固定的方法进行治疗。结果 术后随访12～118个月,平均30个月。Harris髋关节评分从术前的平均45分恢复至随访时的平均89分。19髋达一期愈合，1髋固定失败后再次行大转于张力带固定后愈合。19髋平均愈合时间为166周。所有病例术后均无髋关节脱位。结论 在全髋关节翻修术中使用多枚克氏针加张力带钢丝固定的方法治疗股骨大转子骨折或截骨不愈合，可以提高愈合率，维持正常的髋关节外展肌功能。该方法也适用于大转子粉碎性骨折或骨质疏松的患者。

Treatment of comminuted trochanteric fractures and trochanteric osteotomy non-union in revision total hip arthroplasty

Objective The study was to elucidate the clinical results of the treatment of comminuted trochanteric fractures and trochanteric osteotomy non-union by tension bend in revision total hip arthroplasty. Methods A retrospective study was carried out on 19 patients (20 hips) with comminuted trochanteric fractures or trochanteric osteotomy non-union in 295 revision total hip arthroplasties, treated by the multiple K-wires and tension band fixation during the period from January 1992 to October 1998. The time interval from total hip replacement to the revision was averagely 87 months ranging from 36 months to 122 months. The approach included of anterior lateral approach in 8 hips, posterior in 3 hips and Hardinge in 9 hips. 16 hips were loosening prosthesis associated with osteolysis around prosthesis and bone defects, and 4 hips were symptomatic post non-union trochanteric osteotomy. The reformed Hardinge approach was adopted in all of the patients, the acetabular component was biological fixed in the group, 12 femoral components were biological fixed, and 8 femoral components were cemented. Results The patients were followed up from 12 to 118 months with an average of 30 months. The technique was utilized for intra-operative trochanteric fracture through osteolytic bone in 16 hips and for symptomatic trochanteric nonunion in 4 hips. Thirteen hips utilized the K-wires and tension-band fixation technique only. In five hips, a supplemental Dall-Miles trochanteric grip was added, and in two hips supplemental 3 mm cottony Dacron suture was used to reinforce fixation. The average follow-up was 30 months. The Harris Hip Score improved on average from 45 points preoperatively to 89 points at last follow up. Nineteen hips obtained solid fixation with uneventful healing. On average, radiographic healing had occurred by 16.6 weeks. Perioperative loss of fixation in one patient required repeated surgery. The same method of fixation was utilized at the second operation with a healing. None of the patients experienced a dislocation and few had complications postoperatively. Conclusion The method presented here for fixation of the greater trochanter can improve success rate of healing and maintain the normal function of abductor mechanism in revision hip arthroplasty, especially in patients with trochanteric comminution or poor bone stock.