Judas Fernando, Marques Alexandre, Maximino Luís, Lucas Francisco
Faculty of Medicine, University Clinic of Orthopaedics, Coimbra University Hospitals, Coimbra, Portugal.
Acta Reumatol Port. 2012 Apr-Jun;37(2):187-91.
We report a case of a severe bone loss of the proximal femur with a rapid progression, in a 72-year-old male patient with a stable total revision hip prosthesis. The patient had a persistent mechanical thigh pain. The blood laboratory values were normal. Infection disease and osteolytic bone tumor were excluded. A surgical procedure was performed. The native bone of the proximal femur was resorbed and replaced by a dense fibrous tissue with some sclerotic bone fragments. A large amount of a brownish fluid and a red-brown and friable tissue were found in the pseudojoint cavity. The proximal femur was reconstructed using a large amount of cryopreserved cancellous bone allograft, with retention of the femoral prosthesis. The mechanism of the bone lesion can be related not only to the host response to the wear particles, but mainly to the fluid pressure in the effective joint space. Femoral progressive osteolysis in a stable hip prosthesis is an indication for surgery in useful time, before adverse bone remodeling can begin and lead to major bone loss.
我们报告一例72岁男性患者，其全髋关节置换假体稳定，但股骨近端出现严重骨质流失且进展迅速。患者持续存在大腿机械性疼痛。血液实验室检查值正常。排除了感染性疾病和溶骨性骨肿瘤。实施了手术。股骨近端的天然骨被吸收，代之以含有一些硬化骨碎片的致密纤维组织。在假关节腔内发现大量褐色液体以及红棕色易碎组织。使用大量冷冻保存的松质骨同种异体骨对股骨近端进行重建，保留股骨假体。骨病变的机制不仅可能与宿主对磨损颗粒的反应有关，主要还与有效关节间隙内的流体压力有关。稳定髋关节假体中的股骨进行性骨溶解是在不良骨重塑开始并导致严重骨质流失之前及时进行手术的指征。
