人工髋关节置换术后感染性及迟发性无菌并发症的CT鉴别

CT Diagnosis of Infectious and Delayed Aseptic Complications after Artificial Hip Replacement

目的分析人工髋关节置换术后感染性及迟发性无菌并发症的CT鉴别诊断价值。方法采用随机抽样的方式选取2020年1月-2022年12月在我院进行人工髋关节置换术翻修手术治疗患者80例,男性46例,女性34例;年龄(59.52±5.41)岁;人工髋关节置换术至此次入院时间(53.25±5.54)月。所有患者在进行翻修手术治疗前均进行CT检查,并由两名影像科工作经验≥5年医生采用盲法作出影像学诊断,以术中所见、标本检查结果作为诊断金标准,详细分析CT检查在人工髋关节置换术后感染性及迟发性无菌并发症中的鉴别诊断价值。结果组织病理学诊断结果:感染20例,无菌性松动28例,肉芽肿32例。感染患者CT征象主要表现为无髋臼错位、异位骨化,轻度的骨溶解,重度软组织异常及淋巴结肿大。无菌性松动患者CT征象主要表现为无髋臼错位、异位骨化、软组织异常、淋巴结肿大,多数患者表现为轻度或无骨溶解表现。肉芽肿患者CT征象主要为轻度或无髋臼错位、部分患者存在轻度、重度异位骨化表现,多数患者表现为重度骨溶解以及轻度/重度的软组织异常,多数患者无淋巴结肿大表现。结论CT检查利于临床鉴别诊断人工髋关节置换术后感性并发症及无菌性并发症,可为临床针对性治疗提供充足的支持。

Objective:To analyze the value of CT in differential diagnosis of infectious and delayed aseptic complications after artificial hip replacement.Methods:A total of 80 patients who underwent revision hip replacement in our hospital from January 2020 to December 2022 were randomly selected,including 46 males and 34 females,(59.52±5.41)years;The time from hip replacement to admission was(53.25±5.54)months.All patients underwent CT examination before revision surgery,and the imaging diagnosis was made blind by two doctors with more than 5 years of experience in the imaging department.Intraoperative findings and specimen examination results were used as the gold criteria for diagnosis.The differential diagnosis value of CT examination in the infection and delayed aseptic complications after artificial hip replacement was analyzed in detail.Results:Histopathological diagnosis showed that there were 20 cases of infection,28 cases of aseptic loosening,32 cases of granuloma.CT signs of infected patients were mainly non-acetabular dislocation,ectopic ossification,mild osteolysis,severe soft tissue abnormalities,and lymph node enlargement.CT signs of patients with aseptic loosening were mainly no acetabular dislocation,ectopic ossification,soft tissue abnormalities,and lymph node enlargement,and most patients showed mild or no osteolysis.CT signs of granuloma patients were mainly mild or no acetabular dislocation,mild or severe ectopic ossificationin some patients,severe osteolysis and mild/severe soft tissue abnormalities in most patients,and no lymph node enlargement in most patients.Conclusion:CT examination is beneficial to the clinical differential diagnosis of perceptual complications and aseptic complications after artificial hip replacement,which can provide sufficient evidence for clinical treatment.