异基因造血干细胞移植后股骨头坏死行双髋关节置换术1例报告及文献复习

doi:10.13481/j.1671-587x.20190533

吉林大学学报(医学版) ›› 2019, Vol. 45 ›› Issue (05): 1168-1172.doi: 10.13481/j.1671-587x.20190533

• 临床医学 • 上一篇

异基因造血干细胞移植后股骨头坏死行双髋关节置换术1例报告及文献复习

李金堂, 高航, 黄楷甫, 陈青阳, 李叔强

吉林大学第一医院骨关节外科, 吉林长春 130021

收稿日期:2019-01-15 发布日期:2019-10-08
通讯作者: 李叔强,主任医师,硕士研究生导师(Tel:0431-88785596,E-mail:1656221657@qq.com) E-mail:1656221657@qq.com
作者简介:李金堂(1991-),男,山东省淄博市人,在读医学硕士,主要从事骨病及人工关节置换方面的研究。
基金资助:
国家自然科学基金资助课题（81802077）

Bilateral hip replacement for femoral head necrosis after allogeneic hematopoietic stem cell transplantation: A case report and literature review

LI Jintang, GAO Hang, HUANG Kaifu, CHEN Qingyang, LI Shuqiang

Department of Joint Orthopaedics, First Hospital, Jilin University, Changchun 130021, China

Received:2019-01-15 Published:2019-10-08

摘要/Abstract

摘要： 目的：分析异基因造血干细胞移植后出现双侧股骨头缺血性坏死的骨髓异常增生综合征患者的临床特点，探讨该类患者行双髋关节置换术的围手术期管理、疗效和预后。方法：收集1例异基因造血干细胞移植后出现双侧股骨头缺血性坏死的骨髓异常增生综合征患者的临床资料，包括患者年龄、性别、临床症状、既往病史和转归、辅助检查、治疗方案和预后，并进行相关文献复习。结果：该患者异基因造血干细胞移植后明确诊断为双侧股骨头缺血性坏死，Ficat分期为左侧髋关节Ⅳ期、右侧髋关节Ⅲ期，患者双髋关节疼痛，活动严重受限。入院完善术前实验室检查，经血液科（检查血常规、凝血常规、红细胞沉降率和环孢素浓度）和麻醉科会诊，决定行双侧人工全髋关节置换术。手术顺利，患者术后恢复良好，疼痛症状明显改善，术后第1天即可下地，拄双拐辅助行走，围手术期及术后未出现并发症。术后1个月复查，患者恢复良好，血常规、肝功能、肾功能、红细胞沉降率、C反应蛋白和骨盆正位X线片均未见明显异常。结论：异基因造血干细胞移植后股骨头缺血坏死患者行全髋关节置换术疗效良好，加强围手术期管理能有效预防并发症的发生并提高患者的生活质量。

关键词: 异基因造血干细胞移植, 全髋关节置换术, 骨髓异常增生综合征, 股骨头缺血性坏死, 移植物抗宿主病

Abstract: Objective:To analyze the clinical features of the patient with myelodysplastic syndrome who developed bilateral ischemia necrosis of femoral head after allogeneic hematopoietic stem cell transplantation,and to discuss the perioperative management, efficacy and prognosis of bilateral hip arthroplasty for such patients. Methods:The clinical material of one patient with myelodysplastic syndrome who developed bilateral ischemia necrosis of femoral head after allogeneic hematopoietic stem cell transplantation including age, gender, clinical symptoms, previous medical history and outcomes, auxiliary examinations, treatment regimen and prognosis were collected, and the relevant literatures were reviewed. Results:After allogeneic hematopoietic stem cell transplantation, the patient was diagnosed with bilateral ischemia necrosis of femoral head (Ficat stage:left stage Ⅳ, right stage Ⅲ);the patient presented bilateral hip joint pain and severe limitation of movement. Admission to complete preoperative examination, through multiple consultations of Department of Hematology (blood routine, coagulation routine, erythrocyte sedimentation rate, cyclosporine concentration) and Department of Anesthesiology (blood routine, coagulation routine, liver and kidney function, cardiopulmonary function and lower extremity venous color Doppler), bilateral total hip arthroplasty was decided to perform. The operation went on smoothly,the patient recovered quickly after operation, and the symptoms of pain were improved significantly. The first day after operation, the patient went to the ground, and walked with two crutches. There was no complications during perioperative period and postoperation. One month after operation, the patient recovered well,blood routine examination, liver function, renal function, erythrocyte sedimentation rate, C-reactive protein and pelvic positivity were all normal. Conclusion:Total hip arthroplasty is effective in the patients with bilateral ischemia necrosis of femoral head after allogeneic hematopoietic stem cell transplantation. Strengthening perioperative management can effectively prevent the complications and improve the quality of life of the patients.

Key words: allogeneic hematopoietic stem cell transplantation, total hip arthroplasty, myelodysplastic syndrome, ischemia necrosis of femoral head, graft versus host disease

中图分类号:

R687.4

李金堂, 高航, 黄楷甫, 陈青阳, 李叔强. 异基因造血干细胞移植后股骨头坏死行双髋关节置换术1例报告及文献复习[J]. 吉林大学学报(医学版), 2019, 45(05): 1168-1172.

LI Jintang, GAO Hang, HUANG Kaifu, CHEN Qingyang, LI Shuqiang. Bilateral hip replacement for femoral head necrosis after allogeneic hematopoietic stem cell transplantation: A case report and literature review[J]. Journal of Jilin University(Medicine Edition), 2019, 45(05): 1168-1172.

参考文献

[1] LUECK C, STADLER M, KOENECKE C, et al. Improved short- and long-term outcome of allogeneic stem cell recipients admitted to the intensive care unit:a retrospective longitudinal analysis of 942 patients[J].Intensive Care Med,2018,44(9):1483-1492.
[2] PETSATODIS G E, ANTONARAKOS P D, CHRISTODOULOU AG, et al.Cementless total hip arthroplasty for osteonecrosis of the femoral head after allogenic bone marrow transplantation[J]. J Arthroplasty,2009,24(3):414-420.
[3] SCHULTE C M, BEELEN D W. Bone loss following hematopoietic stem cell transplantation:a long-term follow-up[J]. Blood,2004,103(10):3635-3643.
[4] TORⅡ Y, HASEGAWA Y, KUBO T, et al. Osteonecrosis of the femoral head after allogeneic bone marrow transplantation[J]. Clin Orthop Relat Res,2001,382:124-132.
[5] LUBNER M G, MENIAS C O, AGRONS M, et al. Imaging of abdominal and pelvic manifestations of graft-versus-host disease after hematopoietic stem cell transplant[J]. Am J Roentgenol, 2017,209(1):33-45.
[6] LEDFORD C K, VAP A R, BOLOGNESI M P, et al. Total hip arthroplasty in very young bone marrow transplant patients[J]. J Surg Orthop Adv, 2015,24(2):99-104.
[7] VIJAPURA A, LEVINE H B, DONATO M, et al.Total hip arthroplasty in patients with avascular necrosis after hematopoietic stem cell transplantation[J]. Orthopedics,2018,41(2):e257-e261.
[8] 李子荣, 孙伟, 屈辉,等. 皮质类固醇与骨坏死关系的临床研究[J]. 中华外科杂志, 2005,43(16):1048-1053.
[9] CAMPBELL S, SUN C L, KURIAN S, et al. Predictors of avascular necrosis of bone in long-term survivors of hematopoietic cell transplantation[J]. Cancer,2009,115(18):4127-4135.
[10] WIESMANN A, PEREIRA P, BÖHM P, et al. Avascular necrosis of bone following allogeneic stem cell transplantation:MR screening and therapeutic options[J]. Bone Marrow Transplant, 1998, 22(6):565-569.
[11] MARSTON S B, GILLINGHAM K, BAILEY R F, et al. Osteonecrosis of the femoral head after solid organ transplantation:a prospective study[J]. J Bone Joint Surg Am, 2002, 84(12):2145-2151.
[12] BOQUET J, GOFFIN E, POILVACHE P. Outcome of total knee arthroplasties after renal transplantation[J]. Arch Orthop Trauma Surg, 2008, 128(12):1345-1348.
[13] LEDFORD C K, WATTERS T S, WELLMAN S S, et al. Risk versus reward:total joint arthroplasty outcomes after various solid organ transplantations[J]. J Arthroplasty, 2014, 29(8):1548-1552.
[14] ZADEGAN F, RAOULD A, BIZOT P, et al. Osteonecrosis after allogeneic bone marrow transplantation[J]. Clin Orthop Relat Res, 2008, 466(2):287-293.
[15] CHALMERS B P, LEDFORD C K, STATZ J M, et al. What risks are associated with primary THA in recipients of hematopoietic stem cell transplantation?[J]. Clin Orthop Relat Res, 2017, 475(2):475-480.
[16] MCCLUNE B, MAJHAIL N S, FLOWERS M E. Bone loss and avascular necrosis of bone after hematopoietic cell transplantation[J]. Semin Hematol, 2012, 49(1):59-65.
[17] GONSALVES A, CARRIER M, WELLS P S, et al. Incidence of symptomatic venous thromboembolism following hematopoietic stem cell transplantation[J]. J Thromb Haemost, 2008, 6(9):1468-1473.
[18] GERBER DE, SEGAL JB, LEVY MY, et al. The incidence of and risk factors for venous thromboembolism (VTE) and bleeding among 1514 patients undergoing hematopoietic stem cell transplantation:implications for VTE prevention[J]. Blood, 2008, 112(3):504-510.
[19] PIHUSCH R, SALAT C, SCHMIDT E, et al. Hemostatic complications in bone marrow transplantation:a retrospective analysis of 447 patients[J]. Transplantation, 2002, 74(9):1303-1309.

异基因造血干细胞移植后股骨头坏死行双髋关节置换术1例报告及文献复习

Bilateral hip replacement for femoral head necrosis after allogeneic hematopoietic stem cell transplantation: A case report and literature review

RichHTML

PDF (PC)

赞

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 1

Metrics

本文评价

推荐阅读 0