Brodt S, Eigendorff E, Matziolis G
Klinik für Orthopädie, Friedrich-Schiller Universität Jena, Campus Eisenberg, Eisenberg, Germany.
Acta Chir Orthop Traumatol Cech. 2017;84(3):208-210.
There is a great deal of data available, in part contradictory, on the best fixation technique to use for total hip arthroplasty (THA) in hip osteoarthritis. Both the cementless and the cemented versions offer excellent long-term outcomes - if the respective technique is applied correctly. However, as far as we know, no recommendation has been made regarding cemented vs. cementless THA in primary myelofibrosis. The case described here concerns a very active 76-year-old patient with primary myelofibrosis. This is a rare hematological disease. It develops from clonal hematopoiesis with impaired blood formation and progressive bone marrow fibrosis. An MRI scan of the patients pelvis showed a marked spotted change over all of the imaged bone. Ultimately, in preoperative planning we decided in favor of a proven cementless implant (Allofit Alloclassic cup and the CLS Spotorno stem from Zimmer). Complication-free osseous integration of the cementless implants was observed. Histologic analysis of the bone showed a focally sclerotically altered bone structure. Neither osteoporosis nor osteopenia were found. In our opinion, taking into account all other indication criteria, there is no reason not to perform a cementless THA implantation in the presence of primary myelofibrosis. Key words: hip, primary myelofibrosis, cementless, THA, total hip replacement.
关于髋骨关节炎全髋关节置换术（THA）最佳固定技术的可用数据很多，部分相互矛盾。如果各自的技术应用正确，非骨水泥型和骨水泥型假体都能提供出色的长期效果。然而，据我们所知，对于原发性骨髓纤维化患者行骨水泥型与非骨水泥型THA，尚未给出相关推荐。这里描述的病例是一位76岁、活动能力很强的原发性骨髓纤维化患者。这是一种罕见的血液疾病。它由克隆性造血发展而来，伴有血液生成受损和进行性骨髓纤维化。患者骨盆的MRI扫描显示，所有成像骨骼上均有明显的斑点状改变。最终，在术前规划中，我们决定采用经过验证的非骨水泥型假体（Zimmer公司的Allofit Alloclassic髋臼杯和CLS Spotorno股骨柄）。观察到非骨水泥型假体实现了无并发症的骨整合。对骨骼的组织学分析显示，骨结构有局灶性硬化改变。未发现骨质疏松或骨质减少。我们认为，考虑到所有其他适应证标准，在存在原发性骨髓纤维化的情况下，没有理由不行非骨水泥型THA植入术。关键词：髋关节，原发性骨髓纤维化，非骨水泥型，THA，全髋关节置换术
