摘要
目的 探讨全髋关节置换术（THA）后假体周围骨溶解的影像表现,以提高诊断水平.方法 回顾性分析经手术和病理证实的THA后假体周围骨溶解的髋关节影像资料,总结其影像特征.24例髋关节均行X线平片检查,其中17例行CT平扫.结果 （1）病变部位及类型：假体周围骨溶解发生于股骨23例（层型15例,扩张型8例）（95.8％）,累及股骨Gruen 1～2和6～7区8例（34.8％）,Gruen 1、7区8例（34.8％）,Gruen 1～7区6例（26.0％）,Gruen 2 ～3、6区1例（4.3％）;发生于髋臼21例（层型14例,扩张型7例）（87.5％）,累及髋臼Delee Ⅰ～Ⅲ区14例（66.7％）,DeleeⅠ、Ⅲ区4例（19.0％）,DeleeⅡ～Ⅲ区2例（9.5％）,Delee Ⅰ～Ⅱ区1例（4.8％）.（2）病灶表现：病变区骨皮质不规则变薄24例（100％）,灶状不连续18例（75.0％）、局部消失16例（66.7％）,伴小骨碎片10例（41.7％）,邻近骨皮质局限性增厚3例（12.5％）;病灶边缘硬化21例（87.5％）;杯口状界面18例（75.0％）;行CT平扫的17例中发现软组织肿物16例（94.1％）.（3）假体改变：发现内衬磨损21例（87.5％）;螺钉旁骨质缺损11例（45.8％）,螺钉穿透髋臼内壁3例（12.5％）、断裂2例（8.3％）、内陷1例（4.2％）;假体周围金属碎屑12例（50.0％）.（4）并发症：股骨假体松动19例（79.2％）,髋臼假体松动16例（66.7％）;股骨假体周围骨折11例（45.8％）,髋臼假体周围骨折5例（20.8％）;股骨假体脱位2例（8.3％）.结论 THA后假体周围发现层型或扩张型骨质缺损,伴边界清晰、密度均匀、有包膜的软组织肿物,结合髋臼假体磨损改变,能够对假体旁骨质溶解作出准确的影像诊断.
Objective To explore the imaging appearances of periprosthetic osteolysis after total hip arthroplasty（THA）.Methods Imaging appearances of periprosthetic osteoleysis after THA in 24 cases confirmed by surgery and pathological examination were retrospectively analyzed.Twenty-four patients underwent X-ray examinations,and 17 of them underwent CT scanning additionally.Results （1） Location and type：Of the 24 cases with periprosthetic osteoleysis,23 femurs were involved （95.8%,expansile type in 15 cases and liner type in 8 cases）.Lesions were located in Gruen 1-2 and 6-7 region （34.8%） in 8 cases,in Gruen 1 and 7 region in 8 cases （34.8%）,in Gruen 1-7 region in 6 cases （26.0%）,in Gruen 2-3 and 6 region in one case （4.3%）.A total of 21 actabulums were involved （87.5%,expansile type in 14 cases and liner type in 7 cases included）,with lesions located in Delee Ⅰ-Ⅲ in 14 cases （66.7%）,in Delee Ⅰ and Ⅲ in 4 cases （19.0%）,in Delee Ⅱ-Ⅲ in 2 cases （9.5%） and in Delee Ⅰ-Ⅱ in 1 case （4.8%）.（2） Features of lesions：Adjacent cortex of the lucency lesion appeared irregular thin in 24 cases （100%）,focally discontinuous in 18 cases （75.0%）,disrupted in 16 cases （66.7%）,and accompanied by a few tiny bony fragments in 10 cases （41.7%）.Cortical thickening were seen near the lucency lesion in 3 cases（12.5%）.Twenty-one cases （87.5%） presented with sclerotic margins,18 cases （75.0%） with crateriform interface.Of the 17 cases which underwent the CT scanning,16 cases （94.1%）had soft tissue mass.（3） Change of the prosthesis：Twenty-one cases （87.5%） presented with linear wear,11 cases （45.8%） with bony defect near the screw.The screw penetration was seen in 3 cases （12.5%）,fractured screws were seen in 2 cases （8.3%）,and screw invagination was seen in 1 case （4.2%）,metal debris was seen in 12 cases （50.0%）.（4） Complications：Nineteen cases （79.2%） presented with femur periprosthetic loosening,16 cases （66.7%） with actabulum periprosthetic loosening.Eleven cases （45.8%） presented with femur periprosthetic fractures,5 cases （20.8%） with actabulum periprosthetic fractures.Two cases （8.3%） had periprosthetic dislocation.Conclusions Linear or expansile lucent lesion of the bones around the prosthesis after THA,together with soft tissue mass and the imaging of linear wear can be diagnosed as the periprosthetic osteolysis.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2013年第12期1077-1081,共5页
Chinese Journal of Radiology
