Panagopoulos Andreas, Tatani Irini, Megas Panagiotis
University Hospital of Patras, Adult Reconstructive Surgery Patras, Achaia, Greece.
Open Orthop J. 2016 Dec 30;10:779-784. doi: 10.2174/1874325001610010779. eCollection 2016.
Although ceramic head fracture occurs infrequently today, in the event of a fracture, the resulting revision surgery can prove very challenging, since the ceramic particles lodge into the surrounding soft tissue and can cause rapid implant failure.
A case of long term survivorship of a severed notched femoral stem after replacing the fractured femoral head with a cobalt-chromium one is reported in a 40-year old woman with hip dysplasia who underwent an uncomplicated total hip arthroplasty. The incident of ceramic femoral head fracture occurred 14 months postoperatively without reporting any significant trauma. Intraoperative findings at revision were a multifragmented femoral head and a damaged polyethylene insert along with diffuse metallosis and excessive wear of the cone of the stem. Both the stem and the acetabular component were stable. After removal of ceramic fragments, metallotic tissue excision and careful lavage of the joint, the inlay was replaced by a similar one and a cobalt-chromium femoral head was placed to the existing notched taper of the firmly incorporated stem. At the 13 year follow up examination, the patient had no pain, used no walking aids, and had normal activity with no signs of wearing or loosening in the plain x-rays.
Despite current recommendations of using ceramic femoral heads in cases of fracture or to revise the severely damaged stems we were able to provide a long term survivorship up to 13 years postoperatively of a cobalt-chromium femoral head applied to a severe damaged stem.
尽管如今陶瓷股骨头骨折很少见，但一旦发生骨折，后续的翻修手术会极具挑战性，因为陶瓷颗粒会嵌入周围软组织并可能导致植入物迅速失效。
一名40岁髋关节发育不良女性接受了无并发症的全髋关节置换术，报告了该患者在用钴铬合金股骨头替换骨折的股骨头后，带缺口股骨柄长期存活的病例。陶瓷股骨头骨折发生在术后14个月，且无任何重大创伤报告。翻修术中发现股骨头呈多碎片状，聚乙烯内衬受损，伴有弥漫性金属沉着症以及股骨柄锥度过度磨损。股骨柄和髋臼组件均稳定。在清除陶瓷碎片、切除金属沉着组织并仔细冲洗关节后，用类似的内衬进行替换，并将钴铬合金股骨头安装到牢固植入的股骨柄现有的缺口锥度上。在13年的随访检查中，患者无疼痛，无需使用助行器，活动正常，X线平片无磨损或松动迹象。
尽管目前建议在骨折病例或翻修严重受损股骨柄时使用陶瓷股骨头，但我们能够使应用于严重受损股骨柄的钴铬合金股骨头术后存活长达13年。
