Der Orthopäde

, Volume 42, Issue 5, pp 322–331

Osteotomien des Trochanter major

Leitthema

Zusammenfassung

Mit der zunehmenden Zahl implantierter Hüftendoprothesen stieg auch die Anzahl der Revisionsoperationen. Die Trochanterosteotomie bietet sich als Zugang für die Revisionsendoprothetik an, falls mit weichteiligen Standardzugängen keine genügende Übersicht geschaffen werden kann oder falls der weichteilige Zugang mit einer Traumatisierung funktionell wichtiger Strukturen verbunden wäre. Die Trochanterosteotomien sind muskelschonende Verfahren. Sie werden deshalb auch in der Traumachirurgie und der gelenkerhaltenden Hüftchirurgie (chirurgische Hüftluxation) erfolgreich eingesetzt. Neben einer präzisen Osteotomietechnik ist die stabile Refixierung von besonderer Bedeutung, aber gleichzeitig aufgrund der hohen auf den Trochanter major einwirkenden Muskelkräfte und der in diesem Bereich zarten Kortikalis technisch anspruchsvoll. Es existiert eine Vielzahl an Operationstechniken und Implantaten. Im vorliegenden Beitrag werden gängige traditionelle und neue Osteotomieverfahren am Trochanter major wie die „klassische“ Trochanterosteotomie nach Charnley, die Trochanterverschiebeosteotomie, die erweiterte Trochanterosteotomie und die stufenförmige Trochanterosteotomie sowie die jeweilige Refixationstechnik beschrieben.

Schlüsselwörter

Hüftendoprothesen Revisionsoperationen Trochanterosteotomie Hüftluxation, chirurgische Refixierung, stabile 

Osteotomy of the greater trochanter

Abstract

The increasing number of total hip arthroplasty procedures lead to an increasing number of revision surgeries. The trochanteric osteotomy technique is an established procedure in selected cases with the necessity of extending the usual surgical approach. Trochanteric osteotomy is also successfully performed in other areas, such as trauma surgery and joint-preserving surgery (surgical dislocation). Several techniques for trochanteric osteotomy are availably employing various fixation techniques and implants. This article presents the most common trochanteric osteotomy techniques for extension of the surgical approach (the classical according to Charnley, the trochanter slide, the extended trochanteric, and the stepped osteotomy) as well as clinical results and biomechanical experiences.

Keywords

Hip arthroplasty Revision surgery Trochanteric osteotomy Hip luxation, surgical Refixation, stable 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Klinik für Orthopädie und orthopädische ChirurgieUniversitätsklinikum des SaarlandesHomburg/SaarDeutschland

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