(4) 4-8_Utilização de “espaçador de cimento”

Transcrição

(4) 4-8_Utilização de “espaçador de cimento”
Utilização de “Espaçador de Cimento”
para o Tratamento de Artroplastia Total
de Quadril Infectada
Maurício Morita Sugiyama1, Marcelo Itiro Takano2, Lauro Cardozo
Magalhães Filho1, Daniel Arruda Mello1, Rodrigo Moretti Arantes2, Richard
Armelin Borger2, Rubens Salem Franco2, Roberto Dantas Queiroz3.
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Descritores: Artroplastia, infecção.
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Keywords: Arthroplasty; infection.
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1. Estagiário do grupo do quadril do serviço de ortopedia e traumatologia do HSPE - IAMPE
2. Medico assistente do grupo do quadril do serviço de ortopedia e traumatologia do HSPE - IAMPE
3. Chefe do grupo do quadril e diretor do serviço de ortopedia e traumatologia do HSPE - IAMPE
Técnicas em Ortopedia 2010; 4:4-8
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Figura 1 - Radiografia nas posições frente e perfil visualizando
soltura de componente femoral e áreas de lise
Figura 2- Posicionamento do paciente para abordagem cirúrgica.
Em destaque, cicatrizes previas e fistula purulento ativa.
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Figura 3- Foto intra operatório apresentando fêmur pós limpeza,
debridamento e retirada de componente femoral e cimento
Técnicas em Ortopedia 2010; 4:4-8
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Figura 4 - Espaçador pré-moldado com aumento de volume da
cabeça com cimento ósseo associado à antibiotico
Técnicas em Ortopedia 2010; 4:4-8
Figura 4 - Espaçador pré-moldado
com aumento de volume da cabeça
com cimento ósseo associado à
antibiotico
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Técnicas em Ortopedia 2010; 4:4-8