Greater Trochanteric Fragmentation After Failed Metal-on-Metal Hip Arthroplasty.
Greater Trochanteric Fragmentation After Failed Metal-on-Metal Hip Arthroplasty.
复制标题
金属对金属髋关节置换术失败后出现大粗隆骨折。
DOI：
10.3928/01477447-20150504-93
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发表时间：
2015
期刊：
影响因子：
1.1
通讯作者：
C. Engh
中科院分区：
文献类型：
--
作者：
P. Panichkul;K. Fricka;R. Hopper;C. Engh
髋关节对金属碎屑的不良反应（ARMD）已成为金属对金属髋关节置换术失败和翻修的重要原因。据作者所知，没有关于ARMD翻修后大转子不良影像学后遗症的报告。作者描述了2例患者的临床和影像学结果，这些患者在将失败的髋关节转换为聚乙烯关节面后1 - 2年发生大转子骨折。2例患者均为实体性假瘤伴组织坏死。一些报告描述了ARMD的各种临床特征。尽管在一些翻修手术后结果不佳，但据作者所知，没有报告记录ARMD的大转子骨折。目前的患者强调了这样一个事实，即即使在假瘤被切除后，髋关节置换术后发生的组织损伤也可能涉及骨和软组织，并且翻修后血清金属水平已降至正常水平。与历史上与聚乙烯磨损和骨质溶解相关的大转子骨折不同，骨折前未发现骨囊肿或病变的证据，保守治疗后骨折均未愈合。对于这2例患者，作者认为组织坏死包括软组织和骨。在取出关节面后，坏死的骨逐渐吸收，导致骨碎裂并伴有持续的症状。这些患者强调并提醒我们，损伤不仅限于软组织，还包括骨骼。外科医生应注意影像学检查结果和相关的临床症状。
Adverse reaction to metal debris (ARMD) involving the hip joint has emerged as an important reason for failure and revision among patients with metal-on-metal (MOM) hip arthroplasty. To the authors' knowledge, there are no reports of adverse radiographic sequelae in the greater trochanter subsequent to revision for ARMD. The authors describe clinical and radiographic findings in 2 patients who developed greater trochanteric fragmentation 1 to 2 years after conversion of their failed MOM hips to polyethylene bearings. Both patients had solid pseudotumors with tissue necrosis. Several reports describe various clinical features of ARMD. Although poor outcomes have been demonstrated after some MOM revisions, to the authors' knowledge, no reports document greater trochanter fragmentation in ARMD. The current patients highlight the fact that tissue damage occurring with MOM bearing hips can involve bone in addition to soft tissue even after a pseudotumor has been removed and serum metal levels have decreased to normal levels after revision. Unlike the greater trochanteric fractures historically associated with polyethylene wear and osteolysis, no evidence of bone cysts or lesions was found prior to the fractures and neither fracture healed with conservative treatment. For these 2 patients, the authors believe the tissue necrosis included both soft tissue and bone. The necrotic bone resorbed gradually after removal of the MOM bearing, resulting in bone fragmentation with ongoing symptoms. These patients emphasize and remind us that damage is not only limited to soft tissues, but also includes bone. Surgeons should be aware of this radiographic finding and the associated clinical symptoms.