Tallroth K, Eskola A, Santavirta S, Konttinen Y T, Lindholm T S
Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland.
J Bone Joint Surg Br. 1989 Aug;71(4):571-5. doi: 10.1302/0301-620X.71B4.2768299.
We reviewed 19 patients who presented with aggressive granulomatosis around the femoral stem after hip replacement. All had experienced stress pain and had required revision arthroplasty on average 8.8 years after the primary operation. Fifteen patients were men and four were women; none had rheumatoid arthritis. One patient had an uncemented Moore hemiprosthesis; the others all had cemented total hip replacements. When first detected, the granulomatous lesions were multifocal in 13 patients. The first granuloma was in the region of the lesser trochanter in 10, and near the tip of the stem in only two. Speed of growth varied but on average there was doubling of the area on anteroposterior films in 2.2 years (range 6 months to 4.6 years). Aggressive granulomatous lesions in replaced hips are a distinct condition, different from simple loosening or infection; the lesions may grow rapidly, so revision surgery is indicated soon after diagnosis.
我们回顾了19例髋关节置换术后股骨柄周围出现侵袭性肉芽肿的患者。所有患者均经历过应力性疼痛，在初次手术后平均8.8年需要进行翻修关节成形术。15例为男性，4例为女性；均无类风湿关节炎。1例患者使用非骨水泥型Moore半髋关节假体；其他患者均使用骨水泥型全髋关节置换。首次发现时，13例患者的肉芽肿性病变为多灶性。10例患者的首个肉芽肿位于小转子区域，仅2例位于柄尖附近。生长速度各不相同，但前后位X线片上病变面积平均2.2年翻倍（范围为6个月至4.6年）。置换髋关节中的侵袭性肉芽肿性病变是一种独特的疾病，不同于单纯松动或感染；病变可能迅速生长，因此诊断后应尽早进行翻修手术。
