不良骨水泥的代价:一例慢性髋关节脱位及翻修。

Vasavi Pushadapu, Srikanth Sriramozu, V Sahetya Mohan Rao, Sreekalyani Kothapally
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引用次数: 0

摘要

引言:半关节置换术通常用于老年移位股骨颈骨折患者。虽然通常有效,但不良的骨水泥技术可导致严重的并发症,包括种植体移位和慢性脱位。髋臼内植骨水泥是一种罕见但可预防的持续性不稳定原因。本病例强调了细致的水泥处理和术中警惕的重要性,以避免可避免的翻修手术。病例报告:一位76岁的女性在左侧半关节置换术后8个月出现持续的髋关节疼痛和不活动。术后1个月,患者出现髋关节打滑,卧床不起。检查显示肢体缩短、内收畸形和活动受限。x线片显示髋关节脱位和髋臼多发致密混浊,提示骨水泥介入。计划后路翻修。术前皮肤牵引和内收肌腱切开术治疗软组织挛缩。术中取出与髋臼吻合良好的骨水泥块。将骨水泥整体取出,植入双极假体。术后患者恢复良好,髋关节稳定性和功能得到改善。讨论:本病例说明了骨水泥在椎体干插入过程中,如果提前成熟或过量植入,骨水泥可能会迁移到髋臼。这种介入破坏关节关节,可导致慢性脱位。预防措施——如等待适当的水泥浓度,在髋臼内使用纱布屏障,以及仔细的术中评估——对于避免此类结果至关重要。由于软组织挛缩和生物力学失衡,慢性脱位进一步使手术修复复杂化。全面的术前计划和软组织管理,结合适当的种植体选择,促成了本病例的成功翻修。结论:半关节置换术后骨水泥介入是一种罕见但可预防的慢性脱位原因。该病例强调需要精确的固井技术、仔细的术中评估和积极的管理策略。注意这些细节可以减少并发症并改善老年髋关节置换术患者的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

The Price of Poor Cementing: A Case Report on Chronic Hip Dislocation and Revision.

The Price of Poor Cementing: A Case Report on Chronic Hip Dislocation and Revision.

The Price of Poor Cementing: A Case Report on Chronic Hip Dislocation and Revision.

The Price of Poor Cementing: A Case Report on Chronic Hip Dislocation and Revision.

Introduction: Hemiarthroplasty is commonly performed for displaced femoral neck fractures in elderly patients. While generally effective, poor cementing techniques can lead to serious complications, including implant migration and chronic dislocation. Cement interposition in the acetabulum is a rare but preventable cause of persistent instability. This case emphasizes the importance of meticulous cement handling and intraoperative vigilance to avoid avoidable revision surgeries.

Case report: A 76-year-old woman presented 8 months after left hemiarthroplasty with persistent hip pain and immobility. She had become bedridden 1-month post-surgery following a sensation of hip slippage. Examination revealed limb shortening, adduction deformity, and restricted mobility. Radiographs showed a dislocated hip and multiple dense opacities in the acetabulum, suggesting cement interposition. A posterior approach revision was planned. Pre-operative skin traction and adductor tenotomy were performed to address soft tissue contractures. Intraoperatively, well-formed cement mass conforming to the acetabulum was removed. The cement was removed en bloc, and a bipolar prosthesis was implanted. Post-operatively, the patient achieved satisfactory recovery with improved hip stability and function.

Discussion: This case illustrates the potential for cement to migrate into the acetabulum during stem insertion if introduced pre-maturely or in excess. Such interposition disrupts joint articulation and can lead to chronic dislocation. Preventive steps - such as waiting for appropriate cement consistency, using a gauze barrier in the acetabulum, and careful intraoperative assessment - are critical to avoid such outcomes. Chronic dislocations further complicate surgical revisions due to soft tissue contractures and biomechanical imbalance. Comprehensive pre-operative planning and soft tissue management, combined with appropriate implant selection, contributed to successful revision in this case.

Conclusion: Cement interposition is a rare but preventable cause of chronic dislocation after hemiarthroplasty. This case highlights the need for precise cementing techniques, careful intraoperative assessment, and proactive management strategies. Attention to these details can reduce complications and improve outcomes in elderly patients undergoing hip arthroplasty.

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