全髋关节置换术后髋周炎性假瘤的诊断与治疗

 目的 探讨金属-高分子聚乙烯负重界面全髋关节置换(total hip arthroplasty, THA)术后髋周炎性假瘤的诊断及治疗。方法 2006 年3月至2011 年6 月, 初次金属-高分子聚乙烯负重界面非骨水泥固定THA 术后发生假体周围局灶性骨溶解, 经X 线片和(或)三维CT扫描、超声检查诊断为炎性假瘤7 例(7 髋)。男2 例, 女5 例;年龄32~65岁, 平均48.8 岁。假体稳定固定, 有聚乙烯不对称磨损及髋臼DeLee和Charnley II区局灶性骨溶解, 其中1 例同时有股骨Gruen II区局灶性骨溶解。行炎性假瘤包块切除、骨溶解病灶清除及同种异体颗粒骨植骨, 更换陶瓷-高交联聚乙烯负重界面治疗。结果 7例患者随访3~42 个月, 平均30 个月。无局部炎性假瘤复发、假体周围新发骨溶解及假体松动。4 例假体周围骨溶解区完全被骨组织替代, 2 例有较好的骨长入, 1 例骨长入不明显, 但假体稳定。末次随访时Harris髋关节评分86~100 分, 平均92.4 分。无假体周围感染、异位骨化、假体周围骨折等并发症, 无假体失败而需翻修者。结论 初次THA术后聚乙烯磨损可诱发骨盆内髋周炎性假瘤及假体周围局灶性骨溶解;在手术切除炎性假瘤、清除骨溶解病灶并植骨, 更换负重界面的情况下可保留稳定固定的假体。

Extra-articular inflammatory pseudotumor after well-fixed metal-polyethylene total hip arthroplasty

Objective To retrospectively analyze the diagnosis and treatment of the extra-articular inflammatory pseudotumor after well-fixed metal-polyethylene total hip arthroplasty (THA). Methods From March 2006 to June 2011, 7 patients (7 hips) who presented with a progressive pain and/or swelling, discomfort in groin or upper thigh after metal-polyethylene THA were admitted to our hospital. There were 2 males and 5 females, with an average age of 48.8 years (range, 32-65 years). All 7 patients were identified with a periprosthetic osteolysis at the acetabular and/or femoral components and a mass in the iliac fossa or the thigh; however, the components were all well-fixed. The masses were confirmed by CT scanning and/or ultrasound examination. The revision procedures were done through ilioinguinal approach and posterior-lateral approach, and the pseudotumors were excised and osteolytic lesions were debrided and packed tightly with morselized cancellous allograft. The liner and femoral head were also exchanged at the same time. Clinical and radiographic outcomes of revision THA were evaluated. Results All 7 patients were followed up for 342 months (average, 30 months). At final follow-up, all hips were functioning well and the average Harris hip score was 92.4. All acetabular components remained radiographically well-fixed. All cavitary defects had complete radiographic incorporation of the bone grafts. There were no new pseudotumor or osteolytic lesions identified, and no revision of the components. Conclusion The presence of abdominal or pelvic pseudotumor in patient with a THA may be associated with polyethylene wear. Once the extra-articular pseudotumor and the periprosthetic osteolysis are identified, the surgical treatment, including pseudotumor excise, osteolytic lesion debride and bone defect grafting and bearing surface exchange, can achieve retention of well-fixed components.