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全膝关节置换术后股骨的巨大溶骨性病变。

Massive Osteolytic Lesion of the Femur after Total Knee Arthroplasty.

作者信息

Cardoso Afonso, Amaro Pedro, Gamelas Patrícia, Carvalho E Silva Rita, Oliveira Maria Helena, Correia de Jesus Marcos

机构信息

Orthopaedics Department, Hospital Beatriz Ângelo, Loures, Portugal.

Orthopaedics Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.

出版信息

Arthroplast Today. 2020 Jun 28;6(3):463-469. doi: 10.1016/j.artd.2020.05.016. eCollection 2020 Sep.

DOI:10.1016/j.artd.2020.05.016
PMID:32637517
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7329907/
Abstract

Various failure mechanisms have been identified in total knee arthroplasty (TKA). We hereby present one case of failure, which stands out because of its rapid and destructive progression. We report the case of a 72-year-old Caucasian female patient who developed a large bone osteolytic lesion of the femur after TKA. The patient presented to our hospital 7 years after the initial surgery, complaining of persistent knee pain. The lesion affected the distal half of the femur and, after a diagnostic workup, required a resection of 20 cm and reconstruction with a tumor prosthesis. Subsequent pathological analysis revealed a reaction to cement and prosthesis components. Periprosthetic osteolysis continues to be a major problem, and a reaction to cement and prosthesis components can be an elusive cause of TKA failure.

摘要

全膝关节置换术（TKA）中已发现多种失败机制。我们在此介绍一例失败病例，因其进展迅速且具有破坏性而格外突出。我们报告了一名72岁的白种女性患者，她在TKA术后出现了股骨的大骨溶解性病变。患者在初次手术后7年到我院就诊，主诉膝关节持续疼痛。病变累及股骨远端半部，经过诊断检查后，需要切除20厘米并使用肿瘤假体进行重建。随后的病理分析显示对骨水泥和假体部件有反应。假体周围骨溶解仍然是一个主要问题，对骨水泥和假体部件的反应可能是TKA失败的一个难以捉摸的原因。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9153/7329907/d189f0c3f4f2/gr9.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9153/7329907/b286cdc5a84d/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9153/7329907/3f96ea695ffa/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9153/7329907/cf8b8566cbb4/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9153/7329907/aea5c71a74db/gr4.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9153/7329907/2c6cb4739c0e/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9153/7329907/8f9cab584e4d/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9153/7329907/744549735a28/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9153/7329907/d189f0c3f4f2/gr9.jpg

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本文引用的文献

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Biomed Res Int. 2018 May 13;2018:1412701. doi: 10.1155/2018/1412701. eCollection 2018.
2
A Review of the Literature on Culture-Negative Periprosthetic Joint Infection: Epidemiology, Diagnosis and Treatment.关于培养阴性假体周围关节感染的文献综述：流行病学、诊断与治疗
Knee Surg Relat Res. 2017 Sep 1;29(3):155-164. doi: 10.5792/ksrr.16.034.
3
Metal Hypersensitivity Reactions to Orthopedic Implants.
对骨科植入物的金属超敏反应
Dermatol Ther (Heidelb). 2017 Mar;7(1):53-64. doi: 10.1007/s13555-016-0162-1. Epub 2016 Dec 19.
4
A rare case of pseudotumor formation associated with methyl methacrylate hypersensitivity in a patient following cemented total knee arthroplasty.一例全膝关节置换术后患者发生与甲基丙烯酸甲酯超敏反应相关的假性肿瘤形成的罕见病例。
Skeletal Radiol. 2016 Aug;45(8):1115-22. doi: 10.1007/s00256-016-2372-0. Epub 2016 Mar 29.
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Case series report: Early cement-implant interface fixation failure in total knee replacement.病例系列报告：全膝关节置换术中早期骨水泥-植入物界面固定失败
Knee. 2015 Oct;22(5):424-8. doi: 10.1016/j.knee.2015.02.016. Epub 2015 Mar 17.
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Evaluating the progression of osteolysis after total knee arthroplasty.评估全膝关节置换术后骨溶解的进展情况。
J Am Acad Orthop Surg. 2015 Mar;23(3):173-80. doi: 10.5435/JAAOS-D-13-00189. Epub 2015 Feb 9.
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Osteolysis around total knee arthroplasty: a review of pathogenetic mechanisms.全膝关节置换术后骨溶解：发病机制的综述。
Acta Biomater. 2013 Sep;9(9):8046-58. doi: 10.1016/j.actbio.2013.05.005. Epub 2013 May 10.
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