Suzuki Masahiro, Mikami Takashi
Department of Orthopedic Surgery, Eniwa Hospital, Eniwa, Hokkaido, Japan.
J Orthop Case Rep. 2023 Apr;13(4):41-44. doi: 10.13107/jocr.2023.v13.i04.3608.
Total hip arthroplasty (THA) is widely accepted as a safe and effective procedure to relieve hip pain and restore function, but complications can lead to a poor outcome. Although major vascular injuries during THA are rare, when they do occur, massive bleeding may threaten life.
We describe a case of a 72-year-old woman who underwent THA after rotational acetabular osteotomy (RAO). When the soft tissue in the acetabular fossa was dissected with electrocautery, massive pulsatile bleeding suddenly occurred. A blood transfusion and metal stent graft repair saved her life. We assume that the cause of the arterial injury was a bone defect of the acetabulum and relocation of the external iliac artery after RAO.
To avoid arterial injury during THA, pre-operative three-dimensional computed tomographic angiography to locate the intrapelvic vessels around the acetabulum is recommended in cases with complex hip anatomy.
全髋关节置换术(THA)作为缓解髋关节疼痛和恢复功能的一种安全有效的手术方法已被广泛接受,但并发症可能导致不良后果。虽然THA期间的主要血管损伤很少见,但一旦发生,大量出血可能危及生命。
我们描述了一例72岁女性患者,该患者在髋臼旋转截骨术(RAO)后接受了THA。当用电灼器解剖髋臼窝的软组织时,突然出现大量搏动性出血。输血和金属支架移植修复挽救了她的生命。我们推测动脉损伤的原因是髋臼骨缺损和RAO后髂外动脉移位。
为避免THA期间的动脉损伤,对于髋关节解剖结构复杂的病例,建议术前行三维计算机断层血管造影以定位髋臼周围的盆腔内血管。