Kim Youngwoo, Katsura Yoshiaki, Kasahara Nina, Kasahara Takashi, Kanamura Masashi, Kawanabe Keiichi
Department of Orthopaedics, Shiga Medical Center for Adults, 5-4-30 Moriyama, Moriyama, Shiga, Japan.
Int J Surg Case Rep. 2017;34:115-118. doi: 10.1016/j.ijscr.2017.03.026. Epub 2017 Mar 22.
Infected periprosthetic femoral fractures are among the most complex and significant complications of total hip arthroplasty (THA). We report the novel use of a temporary THA-like spacer for treating an infected periprosthetic femoral fracture after revision surgery using a long stem.
We present a 72-year-old woman sustained a left infected periprosthetic femoral fracture after revi - streptococci in the culture sample. On suspicion of a periprosthetic joint infection, we planned a two-stage procedure. We used a temporary THA-like spacer comprising the removed femoral long stem, which was autoclaved and then reimplanted, and applied a new polyethylene acetabular liner. Both components were cemented in place with antibioticloaded bone cement, without applying strong pressure. Pain control waseasily achieved postoperatively because the fracture had been stabilized early. The THA-like spacer was stable, and allowed a good range of motion without pain. She was allowed to move with a wheelchair and was walk with partial weight bearing without pain. Seven week after the initial THAlike spacer placement, we performed a revision THA after successful control of infection. At the 1-year follow-up, the patient remained free of infection.
Temporary antibiotic-loaded cement-coated THA-like spacer using a long stem facilitated the eradication of infection, fracture stabilization, and enables partial weight bearing without pain.
感染性人工关节周围股骨骨折是全髋关节置换术（THA）最复杂且严重的并发症之一。我们报告了一种新型临时THA样间隔器在使用长柄进行翻修手术后治疗感染性人工关节周围股骨骨折中的应用。
我们介绍了一名72岁女性，在翻修手术后发生左髋感染性人工关节周围股骨骨折，培养样本中发现链球菌。怀疑存在人工关节感染，我们计划进行两阶段手术。我们使用了一个临时THA样间隔器，它由取出的股骨长柄组成，经过高压灭菌后重新植入，并应用了一个新的聚乙烯髋臼衬垫。两个部件均用含抗生素的骨水泥固定到位，未施加强力。由于骨折早期已得到稳定，术后疼痛控制很容易实现。THA样间隔器稳定，允许良好的活动范围且无疼痛。她被允许使用轮椅活动，并能部分负重行走且无疼痛。在最初放置THA样间隔器7周后，在成功控制感染后我们进行了翻修THA手术。在1年随访时，患者未再发生感染。
使用长柄的临时含抗生素骨水泥涂层THA样间隔器有助于根除感染、稳定骨折，并能实现无痛部分负重。
