大腿骨広範骨欠損に対して同種移植骨を用いた人工股関節再置換術の1例

Revision Total Hip Arthroplasty with Massive Proximal Femur Allograft : Case Report

　抄録：広範骨欠損を伴う人工股関節の再置換術は，治療に難渋することが多い．今回われわれは大腿骨近位部広範骨欠損を伴う人工股関節再置換術症例を経験したので報告する．症例は70歳，女性である．右変形性股関節症に対して2回の人工股関節置換術を施行している．大腿骨広範骨欠損を伴う人工関節ルースニングを認めたためmassive bone allograftを用いたセメントレスの人工股関節再々置換術を施行した．短期間ながら良好な成績であり，今後の経過観察が必要であると思われる．諸家の報告では，同種移植骨を用いた再置換術において生存率，臨床成績ともに良好な成績を収めている．本症例においても短期間ではあるが股関節機能の改善が認められた．

　Reconstruction of huge bony defects is one of the most difficult problems in revision total hip arthroplasty (THA). We report a case of re-revision surgery for failed THA with huge proximal femoral segmental defect. Case：A 70-year-old woman had undergone THA twice for osteoarthritis of the hip joint was diagnosed with loosening of the prosthesis and extensive proximal femoral bone loss. Re-revision surgery with a massive bone allograft was performed to salvage the failed cemented THA. This time we used a cementless prosthesis. The patient was allowed to bear half weight at four weeks after the operation and full weight at 10 weeks. At 18 weeks, the patient was able to walk with a crutch and did not experience pain. There has been no radiologic evidence of resorption of the graft. The success of the bone allograft in this procedure has been encouraging. However the follow-up period has been too short, and long-term results are needed to confirm the evidence regarding resorption of the graft.