Kamo Keiji, Kijima Hiroaki, Okuyama Koichiro, Seki Nobutoshi, Yamada Shin, Miyakoshi Naohisa, Shimada Yoichi
Department of Orthopedic Surgery, Akita Rosai Hospital, Odate, Japan; Akita Hip Research Group (AHRG), Akita, Japan.
Akita Hip Research Group (AHRG), Akita, Japan; Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
Case Rep Orthop. 2017;2017:6082302. doi: 10.1155/2017/6082302. Epub 2017 Jan 31.
The present case shows a case of progression of osteolysis of the greater trochanter caused by a foreign body granuloma associated with the number 5 Ethibond suture in cementless THA with the direct lateral approach that was completely healed by removal of the Ethibond suture. A 55-year-old Japanese woman with secondary osteoarthritis caused by acetabular dysplasia underwent left cementless THA with the direct lateral approach. After setting of the total hip prosthesis, the gluteus medius muscle and vastus lateralis muscle were reattached to the greater trochanter through two bone tunnels using number 5 Ethibond EXCEL sutures. The left hip pain disappeared after surgery, but the bone tunnels enlarged gradually and developed osteolysis at 10 weeks. The removal of the Ethibond sutures and debridement improved the osteolysis. Histological examination showed the granuloma reaction to a foreign body with giant cell formation. The Ethibond suture has the lowest inflammatory tissue reaction and relatively high tension strength among nonabsorbable suture materials. However, number 5 Ethibond has the potential to cause osteolysis due to a foreign body granuloma, as in the present case.
本病例显示了一例在采用直接外侧入路的非骨水泥型全髋关节置换术中，由与5号Ethibond缝线相关的异物肉芽肿引起的大转子骨溶解进展情况，通过移除Ethibond缝线后完全愈合。一名55岁因髋臼发育不良导致继发性骨关节炎的日本女性接受了采用直接外侧入路的左侧非骨水泥型全髋关节置换术。全髋关节假体安装后，使用5号Ethibond EXCEL缝线通过两个骨隧道将臀中肌和股外侧肌重新附着于大转子。术后左髋疼痛消失，但骨隧道逐渐扩大并在10周时出现骨溶解。移除Ethibond缝线并进行清创后，骨溶解情况得到改善。组织学检查显示为对异物的肉芽肿反应并伴有巨细胞形成。在不可吸收缝线材料中，Ethibond缝线具有最低的炎症组织反应和相对较高的抗张强度。然而，如本病例所示，5号Ethibond缝线有因异物肉芽肿导致骨溶解的可能性。
