Veselý F, Novotný K, Sosna A
I. Ortopedická klinika 1. LF UK a FN Motol, Praha.
Acta Chir Orthop Traumatol Cech. 2009 Dec;76(6):509-12.
Reimplantation of a total hip arthroplasty (THA) with excessive heterotopic polyethylene granuloma is reported. An 84- year-old woman, who had undergone THA reimplantation on the right side 4.5 years previously, was indicated for revision surgery due to aseptic failure of the acetabular component. Pre-operative examination revealed a pulsating mass below the right inguinal ligament that raised the suspicion of a pseudoaneurysm of the external iliac artery. Because of this suspected late complication of the first revision arthroplasty, surgical exploration was indicated by the vascular surgeon prior the second reimplantation. A CT-scan showed a large mass attached to a preserved lumen of the external iliac artery, and this was diagnosed by the vascular surgeon as a pseudoaneurysm. However, no pseudoaneurysm was found by a vascular surgery procedure, and the large mass ventrally extending the external iliac artery appeared to be a large polyethylene granuloma well enveloped in a fibrous pseudocapsula. The granuloma was removed and the wound sutured. Twelve days later, revision total hip arthroplasty and acetabular reconstruction were successfully carried out.
据报道，有一例全髋关节置换术（THA）再植入时出现大量异位聚乙烯肉芽肿的病例。一名84岁女性，4.5年前曾接受右侧THA再植入手术，因髋臼组件无菌性失效而需进行翻修手术。术前检查发现右侧腹股沟韧带下方有一搏动性肿块，怀疑是髂外动脉假性动脉瘤。由于怀疑这是首次翻修关节成形术的晚期并发症，血管外科医生在第二次再植入手术前进行了手术探查。CT扫描显示一个大肿块附着在髂外动脉的保留管腔上，血管外科医生将其诊断为假性动脉瘤。然而，血管外科手术未发现假性动脉瘤，而腹侧延伸至髂外动脉的大肿块似乎是一个包裹在纤维假包膜内的大聚乙烯肉芽肿。切除肉芽肿并缝合伤口。12天后，成功进行了翻修全髋关节置换术和髋臼重建。
