Dall進入路における大転子部合併症について

Complications involving the Greater Trochanter Associated with the Modified Transgluteal Approach (Dall) for THA

　抄録：当院では主にDallの進入路にて人工股関節全置換術（THA）を施行してきたが，術中，術後に大転子骨折，切離骨片の転位等の合併症を経験し，その発生頻度，発生時期等を調査した．Dallの進入路にてTHAを施行されX線像で評価可能であった105例118関節を対象とした．大転子骨折は11関節に認められ，変形性股関節症（OA）群では6.1％，関節リウマチ（RA）群では15％の発生率であった．切離骨片の転位は15関節に認められ，OA群中16％，RA群中5％の発生率であった．大転子骨折は2関節では術中に，9関節では術後2週間以内に発生していた．大転子骨折に対し5関節に整復固定術を施行し骨癒合を認めた．保存的に加療した6関節のうち，4関節は偽関節となった．切離骨片転位例では骨癒合を9関節に，偽関節を6関節に認めた．また術後股関節脱臼を大転子合併症なし群では1例に，大転子合併症あり群では3例に認めた．大転子骨折はRAに，切離骨片の転位はOAに多い傾向を認めた．また大転子合併症は脱臼の危険因子になると思われた．

　Dall's modified transgluteal approach was used to perform and 121 total hip arthroplasties at our institution between 1993 and 2002, complications involving the greater trochanter developed in 26 of them. Follow-up radiographs could be evaluated in 118 cases (OA 78, RA 40). A fracture of the remaining greater trochanter had occurred in eleven cases. The rate of complication by fracture was 6.1％in OA and 15％in RA. Two of the fractures occurred during surgery, and the other nine occurred within 2 weeks after surgery. Three patients required open reduction and internal fixation, and sound union resulted in all three cases. Union was achieved in four of the eight patients treated conservatively. Proximal displacement (＞10mm) of the osteotomized fragment occurred in fifteen patients, and the complication rate was 16％in OA and 5％in RA. Nonunion after reattachment was diagnosed in six patients on the basis of lateral view radiographs of the hips. Dislocation of the greater trochanter occurred as a complication in three hips. This study suggests that complications in greater trochanter are a risk factor for dislocation of the hip.