Ochi Hironori, Takagi Tatsuya, Baba Tomonori, Nozawa Masahiko, Kim Sung-Gon, Sakamoto Yuko, Kato Suguru, Homma Yasuhiro, Kaneko Kazuo, Ishijima Muneaki
Department of Orthopaedics Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.
Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Trauma Case Rep. 2021 Feb 26;32:100447. doi: 10.1016/j.tcr.2021.100447. eCollection 2021 Apr.
Most surgical treatment options for metastatic acetabular lesions involve variants of total hip arthroplasty (THA). However, these are technically complex reconstructions performed in very frail patients, and previous reports indicate complications such as dislocation, deep infection, aseptic loosening, and intraoperative death. A 73-year-old man presented to the emergency department at our hospital with right hip pain following a fall. He had undergone nephrectomy for the treatment of right kidney cancer at the age of 68 years. Four years after the nephrectomy, multiple lung metastases, pelvic bone metastases, and right femoral head and neck bone metastases were found. A radiograph of the hip joint showed a pathological proximal femoral fracture with a radiolucent lesion of the acetabulum. THA with acetabular reconstruction using a Kerboull-type (KT) plate through the direct anterior approach (DAA) was performed. After removal of the femoral head, curettage of the metastatic acetabular dome lesion was carefully performed under fluoroscopic guidance. After the KT plate was placed, cementation of the metastatic acetabular dome lesion was performed, and an optimally sized polyethylene liner was fixed with cement. A cemented stem was inserted after confirming the hip joint stability. At the 14-month follow-up, he could walk steadily without any complications and his modified Harris hip score was 100. The DAA conserves soft tissue because it is an intermuscular approach. Accordingly, postoperative recovery is fast and thus associated with a low dislocation rate and effective pain reduction. The acetabulum with metastatic disease was reconstructed using a KT plate for hip joint stability. Bone with metastatic disease that appears adequate at the time of THA may become incompetent after a few years. THA with acetabular reconstruction using a KT plate through the DAA was an effective treatment for metastatic bone disease of the acetabulum combined with pathological proximal femoral neck fracture.
转移性髋臼病变的大多数手术治疗方案都涉及全髋关节置换术（THA）的变体。然而，这些手术在非常虚弱的患者中进行，技术上较为复杂，且既往报道显示存在脱位、深部感染、无菌性松动和术中死亡等并发症。一名73岁男性因跌倒后出现右髋疼痛就诊于我院急诊科。他在68岁时因右肾癌接受了肾切除术。肾切除术后四年，发现多处肺转移、骨盆骨转移以及右股骨头和颈部骨转移。髋关节X线片显示股骨近端病理性骨折，髋臼有透亮病变。通过直接前路（DAA）使用Kerboull型（KT）钢板进行髋臼重建的THA手术。切除股骨头后，在透视引导下仔细刮除转移性髋臼穹窿病变。放置KT钢板后，对转移性髋臼穹窿病变进行骨水泥填充，并使用骨水泥固定尺寸合适的聚乙烯内衬。确认髋关节稳定性后插入骨水泥型股骨柄。在14个月的随访中，他能够稳步行走，无任何并发症，改良Harris髋关节评分100分。DAA是一种肌间隙入路，可保留软组织。因此，术后恢复快，脱位率低，能有效减轻疼痛。使用KT钢板重建患有转移性疾病的髋臼以维持髋关节稳定性。在THA时看似足够的患有转移性疾病的骨可能在几年后变得功能不全。通过DAA使用KT钢板进行髋臼重建的THA是治疗髋臼转移性骨病合并病理性股骨近端骨折的有效方法。
