Tang Yilun, Xu Yan, Shi Zhibin, Ma Xiaorong, Fan Lihong, Wang Kunzheng, Dang Xiaoqian
The FirstOrthopedics Department Department of Hematopathology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xian, Shaanxi, China.
Medicine (Baltimore). 2018 Apr;97(15):e0308. doi: 10.1097/MD.0000000000010308.
Refractory immune thrombocytopenic purpura (RITP) manifests as low platelet count, with a high risk of hemorrhage, treatment difficulty, and high mortality. Total hip arthroplasty (THA) in RITP is rarely reported. This study aimed to evaluate multiple THAs or revision total hip arthroplasties (RTHAs) in RITP.
The male patient with RITP was 54-year-old patient and hospitalized on September 21, 2009, with the main complaint of bilateral hip pain after traveling for 2 weeks. The patient had a history of ITP for 16-years, with no response to hormone therapy (after adequate hormone therapy, platelet count persistently remained below 30 × 10/L). Two year prior to visit, the patient underwent splenectomy, and postoperative platelet persistently fluctuated around 10 to 20 × 10/L. The patient did not undergo regular reexaminations, and declined immunosuppressants.
Femoral neck fracture; Refractory immune thrombocytopenic purpura (RITP).
A RITP patient with femoral neck fracture received 2 THAs and 1 RTHA. First THA indication was significant left dislocation of Garden III type. RTHA was performed following prosthetic loosening after left total hip arthroplasty. The second THA was prompted by non-healing of the old fracture, significant pain, and a low Harris score. Platelet count remained <20 × 10/L, and conventional drugs, splenectomy, and platelet transfusion had no effects. A large gamma-globulin dose was administered preoperatively. When platelet increased to 75 × 10/L, 2 THAs and 1 RTHA were successfully completed.
Postsurgery, conventional management was applied; no severe complications occurred. The wound was well healed, with platelet count reduced to <15 × 10/L at hospital discharge. The patient recovered, with a Harris score >80 at 1 year postsurgery.
Extremely low platelet count is a contraindication of surgery. In this patient, preoperative platelet count was <100 × 10/L. Extended disease course and multiple operations lowered platelet count, and increased risk in surgery. However, high postoperative gamma-globulin dose impacted therapy, and all surgeries were successful, with no severe complications. The wound healed well, and the quality of life was significantly improved, demonstrating the feasibility and safety of this surgery. Multiple THA or RTHA surgeries are feasible and safe for RITP patients.
难治性免疫性血小板减少性紫癜（RITP）表现为血小板计数低，出血风险高，治疗困难且死亡率高。RITP患者行全髋关节置换术（THA）的报道很少。本研究旨在评估RITP患者行多次THA或翻修全髋关节置换术（RTHA）的情况。
该男性RITP患者，54岁，于2009年9月21日入院，主要诉旅行2周后双侧髋部疼痛。患者有ITP病史16年，对激素治疗无反应（充分激素治疗后，血小板计数持续低于30×10⁹/L）。就诊前2年，患者接受了脾切除术，术后血小板持续在10至20×10⁹/L波动。患者未定期复查，拒绝使用免疫抑制剂。
股骨颈骨折；难治性免疫性血小板减少性紫癜（RITP）。
一名患有股骨颈骨折的RITP患者接受了2次THA和1次RTHA。首次THA的指征是Garden III型左侧严重脱位。左全髋关节置换术后假体松动后进行了RTHA。第二次THA是由于陈旧性骨折不愈合、严重疼痛和Harris评分低而进行的。血小板计数仍<20×10⁹/L，常规药物、脾切除术和血小板输注均无效。术前给予大剂量丙种球蛋白。当血小板升至75×10⁹/L时，成功完成了2次THA和1次RTHA。
术后采用常规处理；未发生严重并发症。伤口愈合良好，出院时血小板计数降至<15×10⁹/L。患者康复，术后1年Harris评分>80分。
极低的血小板计数是手术的禁忌证。该患者术前血小板计数<100×10⁹/L。病程延长和多次手术使血小板计数降低，增加了手术风险。然而，术后高剂量丙种球蛋白影响了治疗效果，所有手术均成功，无严重并发症。伤口愈合良好，生活质量显著改善，证明了该手术的可行性和安全性。多次THA或RTHA手术对RITP患者是可行且安全的。
