CT扫描在髋关节置换术后骨盆骨溶解诊断的价值

Value of CT scan in diagnosis of pelvic osteolysis after total hip arthroplasty

[目的]探讨CT扫描在全髋关节置换（total hip arthroplasty,THA）术后骨盆骨溶解诊断中的价值。[方法]2006-2009年,华西医院骨科共收治24例24髋THA术后骨盆骨溶解患者。收集24例患者的骨盆前后位、股骨颈正斜位、45°髋骨斜位、45°闭孔斜位X线片和髋关节CT扫描影像检查资料,对照术中发现,分析、比较CT扫描在临床诊断中的价值。[结果]骨盆前后位X线片明确骨溶解13例,占54.2%;骨盆前后位结合股骨颈正斜位X线片明确骨溶解病灶18例,占75%;骨盆前后位、股骨颈正斜位、髋骨斜位和闭孔斜位X线片明确骨溶解病灶22例,占91.7%;CT扫描发现骨溶解病灶24例,占100%。CT扫描评估骨盆骨溶解病灶部位和范围比X线片更加精确。[结论]CT扫描诊断骨溶解比X线片具有更高的灵敏度和特异度,并且可以精确确定骨溶解部位和范围。

[Objective]To evaluate the value of CT scan in pelvic osteolysis diagnosis after total hip arthroplasty. [Methods]Twenty-four patients（24 hips） diagnosed as periprosthetic pelvic osteolysis after primary total hip arthroplasty were retrospectively reviewed.Data on anteroposterior and iliac oblique plain radiographs as well as axial,coronal and sagittal computed tomography scans were evaluated to determine the presence and location of any periacetabular osteolytic lesions.These results were compared with those of the intraoperative findings.[Results]Periprosthetic osteolytic lesions were identified on AP radiograph in 13 hips（54.2 %）,on AP and femoral neck oblique radiograph in 18 hips（75 %）,on four views radiograph in 22 hips（91.7%）,and on CT scan in 24 hips（100%）,respectively.Computed tomography had a high positive rate in periprosthetic osteolysis diagnosis compared to the X-ray examination.From the CT images,the author identified the location and measured the size of the osteolytic lesions.[Conclusion]Computed tomopraphy has a high sensitivity and specificity in osteolytic lesion diagnosis compared to the plain radiography.It is an accurate method for detecting the location and measuring the size of periacetabular osteolytic lesions.