多排螺旋CT在人工髋关节翻修术前评估的价值

Application of multi-row spiral CT in the preoperative assessment of revision surgery after artificial hip replacement

目的探讨多排螺旋CT在人工髋关节翻修术前评估的应用。方法回顾性分析2014年3月~2019年5月在南方医科大学第三附属医院行人工髋关节翻修术的21例患者资料,其中男性7例,女性14例,中位年龄62岁,共21髋,包括假体松动13髋,假体脱位2髋,假体周围骨折2髋,旷置术后4髋,均于翻修术前行多排螺旋CT检查。由2名放射科医师阅读CT图像,分析假体失败的CT征象及为翻修术手术方案制定提供参考。结果假体松动13髋,包括髋臼侧假体松动10髋,CT上均可见假体向上向内移位,4髋假体旁见明显透亮线,2髋髋臼内充填大量软组织,2髋髋臼周围有明显的骨质缺损;股骨侧人工假体松动6髋,5髋可见假体移位,2髋可见假体旁明显透亮线,1髋未见明显放射学异常。合并髋臼侧假体内衬磨损1髋,其髋臼侧及股骨侧假体正常间隙消失。假体脱位2髋,表现为股骨头明显向髋关节外上后方移位,髋臼骨质缺损。假体周围骨折2髋,表现为股骨侧假体(股骨柄)末端或中段旁骨质断裂,2髋均合并假体松动。旷置术后4髋,CT上可见存留的假体及间置器、髋臼内填充软组织等,3髋可见髋臼较明显的骨质缺损。结论多排螺旋CT可检测人工髋关节失败的原因,协助翻修术方案的制定。

Objective To explore the application of multi-row spiral CT in the preoperative assessment of revision surgery after artificial hip replacement.Methods From March 2014 to May 2019,21 patients(21 hips)of revision surgery after artificial hip replacement in the Third Affilated Hospital of Southern Medical University were included.There were 7 males and 14 female,with median age of 62 years old.The reasons of revision surgery included 13 hips of prosthesis loosening,2 hips of prosthesis dislocation,2 hips of periprosthesis fracture,and 4 hips of two-stage exchange.CT examinations were performed to all hips before revision surgery.Two radiologists reviewed the CT images to analyze the radiologic sign of failure of prosthesis and develop a proposal for the revision surgery.Results Among 13 hips of prosthesis loosening,there were 10 hips with artificial acetabulum loosening,which reperent prosthesis shifting upward and inward of all 10 hips,obvious lucent areas of periprosthesis of 4 hips,massive soft tissues filling in the acetabulum of 2 hips,bony defect of the acetabulum of 2 hips.There were 6 hips with artificial femoral loosening,which repesented as prosthesis shifting of 5 hips,obvious lucent areas of periprosthesis of 2 hips,and no definitely abnormal findings of 1 hip.Addtionally,1 hip with prosthesis loosening coexisted lining abrasion,manifesting as vanish of interval of artificial acetabulum and femoral.There were 2 hips with dislocation of prosthesis,which represented as femoral heads dislocating out of acetabulum laterally,superiorly,posteriorly.There were 2 hips with periprosthesis fractures,which represented as broken bones round the middle segment or the distal of the prosthesis.The both hips were suffered from prosthesis loosening.There were 4 hips of two-stage exchange,which showed residual prosthesis,spacers,soft tissues in the acetabulum on CT images,among which obvious bony defect were found in the acetabulum of 3 hips.Conclusion Multi-row spinal CT could reveal factors of prosthesis failure,and develop a proposal for the revision surgery after artificial hip replacement.