微创全髋关节置换后的影像学评估

Imaging evaluation after minimally invasive total hip arthroplasty

背景:微创全髋关节置换后难免发生并发症,目前临床常用术后评估的影像学手段多种多样,各有利弊。目的:介绍X射线片、CT、MRI等影像学检查在微创全髋关节置换后疗效评估方面的应用价值及研究进展。方法:由第一作者检索PubMed数据库、中国知网、万方数据库中2000至2020年出版的文献,英文检索词为"surgical injury,MRI,minimally invasive,muscle trauma";中文检索词为"微创全髋关节置换术,影像,评估,肌肉损伤",对微创全髋关节置换过程中不同入路的特点及其对髋周肌群影响的影像检查结果进行总结分析。结果与结论:①X射线片是全髋关节置换后患者复查的首选检查;②骨单光子发射CT不易受到金属伪影的影响,在关节置换患者中显示出更高的敏感性和特异性;③MRI成为评估髋周肌群,特别是肌肉形态学改变的金标准;④血清炎性细胞因子水平作为肌肉损伤的标志物,是评估微创全髋关节置换的一种特异而客观的方法;⑤提示微创全髋关节置换极大地避免了肌肉和肌腱的切开或剥离,减少了术后髋关节脱位及脂肪液化坏死等风险;老年患者因其肌肉修复再生能力减弱,在进行全髋关节置换过程中使用微创术式有着独特的临床价值;影像学检查能够客观准确地评估微创手术的患者获益。

BACKGROUND: Complications are unavoidable after minimally invasive total hip arthroplasty. At present, the imaging methods commonly used in clinical postoperative evaluation are diverse, and each has advantages and disadvantages. OBJECTIVE: To introduce the application value and research progress of X-ray, CT, MRI and other imaging examination in the evaluation of curative effect after minimally invasive total hip arthroplasty.METHODS: The first author retrieved the literature published in the Pub Med, CNKI, and Wanfang database from 2000 to 2020. The key words were "surgical injury, MRI, minimally invasive, muscle trauma" in English, and "minimally invasive total hip arthroplasty, imaging, evaluation, muscle injury" in Chinese. The characteristics of different approaches of minimally invasive total hip arthroplasty and the imaging examination results of their effects on hip muscles were summarized and analyzed. RESULTS AND CONCLUSION:(1) X-ray is the first choice for reexamination of patients after total hip arthroplasty.(2) Single photon emission CT of bone is not easy to be affected by metal artifacts, and shows higher sensitivity and specificity in patients with joint replacement.(3) MRI is the gold standard for the evaluation of peripheral muscle groups, especially muscle morphological changes.(4) The level of serum inflammatory cytokines, as a marker of muscle injury, is a specific and objective method for evaluating minimally invasive total hip arthroplasty.(5) Minimally invasive total hip arthroplasty can greatly avoid the incision or separation of muscles and tendons and reduce the risk of hip dislocation and fat liquefaction and necrosis after operation. Because of the weakening of muscle repair and regeneration ability in elderly patients, minimal invasion in total hip arthroplasty has a unique clinical position. Imaging examination plays an important role in the evaluation of minimally invasive surgery.