Department of Orthopedics, AIIMS Bhubaneswar, Bhubaneswar, India
Department of Orthopedics, AIIMS Bhubaneswar, Bhubaneswar, India.
BMJ Case Rep. 2023 Aug 22;16(8):e255085. doi: 10.1136/bcr-2023-255085.
Total hip arthroplasty (THA) in patients with ipsilateral mid-thigh amputation is surgically challenging. We report a case of same setting THA and ipsilateral above-knee amputation in a male patient. The patient had 8 months old neglected neck femur fracture and ipsilateral femur shaft fracture with 14 cm bone loss. There was an associated neurovascular (femoral artery injury and sciatic nerve palsy) deficit at the initial insult; however, the limb survived because of well-formed collaterals. The limb was insensate at the time of presentation because of complete sciatic nerve palsy. The decision to undergo amputation was taken based on insensate limb, compromised circulation and huge bone loss with healed open fracture. After 10 months follow-up, the patient was walking with prosthesis limb fitted to the amputated mid-thigh stump and there were no incidences of osteolysis, subsidence or infection in the THA site.
同侧大腿截肢患者行全髋关节置换术（THA）具有一定的挑战性。我们报告了 1 例同侧高位截肢和 THA 的病例，患者为男性。他 8 个月大时患有陈旧性股骨颈骨折和同侧股骨干骨折，伴有 14 cm 的骨缺损。初次损伤时存在合并的神经血管（股动脉损伤和坐骨神经麻痹）缺损；然而，由于形成了良好的侧支循环，肢体得以存活。就诊时由于完全性坐骨神经麻痹，肢体感觉丧失。由于感觉丧失的肢体、循环受损以及巨大的骨缺损伴愈合性开放性骨折，决定进行截肢。10 个月随访时，患者已用安装在截肢大腿残端的假体行走，THA 部位无骨溶解、下沉或感染发生。
