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全股骨置换术——病例报告

Total Femoral Replacement- A Case Report.

作者信息

Guerra Jose, Chaghouri Patrick, Guerra Jose Andres, Peters Sophia Lorina

机构信息

Department of Surgery, University of Toronto, Scarborough Health Network, Ontario, Canada.

出版信息

Geriatr Orthop Surg Rehabil. 2021 Jun 18;12:21514593211019977. doi: 10.1177/21514593211019977. eCollection 2021.

Abstract

Total femoral replacement(TFR) is a well-recognized salvage procedure performed after multiple failed endoprosthetic replacements, which result in severely compromised bone stock and damaged structural integrity. TFR is performed as an alternative to lower limb amputation, restoring femoral integrity and enabling patients to resume ambulation. TFR is expected to be performed more frequently as the worldwide rate of revision arthroplasty increases due to improved patient survival rates and their underlying diseases, exceeding the functional life of endoprosthetic arthroplasty. We present a 74-year-old, overweight woman with an extensive surgical history with respect to her right knee. Her right lower extremity x-rays showed a long-cemented stem knee tumour prosthesis and a Garden 4 subcapital fracture of the ipsilateral hip. Due to multiple surgeries of the knee and femur in the past, a total femoral replacement was required to be performed. The procedure was successful, and the expected outcome was met. A successful procedure performed by a skilled and experienced surgical team, a thorough rehabilitation program, and prompt post-operative management of complications, can overcome the high incidence of infection and dislocation to preserve the limb with improved functionality and reduce pain. TFR is a drastic operative intervention that can preserve the quality of life for most patients.

摘要

全股骨置换术(TFR)是一种在多次假体置换失败后进行的公认的挽救性手术,这些失败导致骨量严重受损和结构完整性破坏。TFR作为下肢截肢的替代方法进行,可恢复股骨完整性并使患者能够恢复行走。随着全球翻修关节成形术的发生率因患者生存率及其基础疾病的改善而增加,超过了假体关节成形术的功能寿命,预计TFR的实施会更加频繁。我们报告一名74岁、超重的女性,其右膝有广泛的手术史。她的右下肢X线片显示有一个长柄骨水泥固定的膝关节肿瘤假体以及同侧髋部的Garden 4型股骨颈基底骨折。由于过去膝关节和股骨进行过多次手术,需要进行全股骨置换术。手术成功,达到了预期效果。由技术熟练且经验丰富的手术团队实施成功的手术、全面的康复计划以及对并发症的及时术后处理,能够克服感染和脱位的高发生率,以保留具有改善功能且减轻疼痛的肢体。TFR是一种激进的手术干预措施,可为大多数患者保留生活质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/487c/8216370/adda29ba7ab9/10.1177_21514593211019977-fig2.jpg

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