CAJ | 학술논문

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.
목적 탐토전관관절치환술(THA)후가체주위골용해적영상표현,이제고진단수평.방법 회고성분석경수술화병리증실적THA후가체주위골용해적관관절영상자료,총결기영상특정.24례관관절균행X선평편검사,기중17례행CT평소.결과 (1)병변부위급류형:가체주위골용해발생우고골23례(층형15례,확장형8례)(95.8％),루급고골Gruen 1～2화6～7구8례(34.8％),Gruen 1、7구8례(34.8％),Gruen 1～7구6례(26.0％),Gruen 2 ～3、6구1례(4.3％);발생우관구21례(층형14례,확장형7례)(87.5％),루급관구Delee Ⅰ～Ⅲ구14례(66.7％),DeleeⅠ、Ⅲ구4례(19.0％),DeleeⅡ～Ⅲ구2례(9.5％),Delee Ⅰ～Ⅱ구1례(4.8％).(2)병조표현:병변구골피질불규칙변박24례(100％),조상불련속18례(75.0％)、국부소실16례(66.7％),반소골쇄편10례(41.7％),린근골피질국한성증후3례(12.5％);병조변연경화21례(87.5％);배구상계면18례(75.0％);행CT평소적17례중발현연조직종물16례(94.1％).(3)가체개변:발현내츤마손21례(87.5％);라정방골질결손11례(45.8％),라정천투관구내벽3례(12.5％)、단렬2례(8.3％)、내함1례(4.2％);가체주위금속쇄설12례(50.0％).(4)병발증:고골가체송동19례(79.2％),관구가체송동16례(66.7％);고골가체주위골절11례(45.8％),관구가체주위골절5례(20.8％);고골가체탈위2례(8.3％).결론 THA후가체주위발현층형혹확장형골질결손,반변계청석、밀도균균、유포막적연조직종물,결합관구가체마손개변,능구대가체방골질용해작출준학적영상진단.
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.