Siddhartha Dandamudi BBA , Joyee Tseng BS , John Ratz BS , Lisa Boggio MD, MS , Brett R. Levine MD, MS
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引用次数: 0
摘要
在每年进行的全髋关节置换术中,股骨头血管性坏死(AVN)的发生率高达 10%。AVN 通常与血管内凝血有关,但在 B 型血友病等出血性疾病患者中却极为罕见。在本报告中,我们介绍了一名 46 岁 B 型血友病男性患者的治疗方法,该患者出现慢性左髋关节疼痛和股骨头无血管坏死。他的腹股沟疼痛持续了 6 个月,没有拐杖的帮助无法行走。X光片显示,股骨头坏死继发关节退行性病变。在用尽各种治疗方案后,患者选择进行选择性全髋关节置换术。多学科团队需要进行复杂的术前规划和血友病管理,以降低出血风险并促进手术成功。术后,患者肌酐短期内有所升高,但未出现出血并发症。长期随访显示,患者功能明显改善,未出现任何 B 型血友病并发症。目前还没有报告概述 B 型血友病(IX 因子缺乏症)患者的房室缺损情况,也没有为这些患者制定成功实施髋关节置换术的逐步治疗策略。
Total Hip Arthroplasty for Avascular Necrosis in a Patient With Hemophilia B
Avascular necrosis (AVN) of the femoral head accounts for up to 10% of all total hip arthroplasties performed annually. Typically associated with intravascular coagulation, AVN is extremely rare in patients with bleeding disorders such as hemophilia B. In this report, we describe the therapeutic management of a 46-year-old male with hemophilia B, presenting with chronic left hip pain and AVN of the femoral head. He presented with progressive groin pain for 6 months and was unable to ambulate without the assistance of crutches. Radiographs showed evidence of degenerative joint disease secondary to AVN of the femoral head. After exhausting treatment options, the patient elected to proceed with an elective total hip arthroplasty. Intricate preoperative planning and hemophilia management were required by a multidisciplinary team to mitigate bleeding risks and promote success of the surgery. Postoperatively, the patient experienced a short-term rise in creatinine, but experienced no bleeding complications. The long-term follow-up revealed significant functional improvement without any complications of hemophilia B. There are no reports outlining AVN in hemophilia B (factor IX deficiency) or step-by-step treatment strategies for successful hip replacement in these patients.
期刊介绍:
Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.