骨科内植物植入术后局部软组织病变的超声应用价值  

Ultrasound in Local Soft Tissue Lesions After Orthopaedic Implant Surgery

作　　者：袁宇[1] 高金妹[1] 郭林[2] 谷超[3] 

机构地区：[1]天津市天津医院超声科,天津300211 [2]天津市天津医院放射科,天津300211 [3]天津医科大学基础医学院,天津300070

出　　处：《中国医学影像学杂志》2015年第7期549-552,共4页Chinese Journal of Medical Imaging

摘　　要：目的骨科手术后,进行CT或MRI检查时金属内植物的伪影常严重影响图像质量,局部软组织病变显示受限,本研究旨在探讨金属内植物植入术后超声检查对局部软组织病变的应用价值。资料与方法对70例各种骨科金属内植物植入术后手术区域进行超声检查,记录包括病灶的形态、大小、内部回声、边缘情况、有无包膜及钙化、血流情况等声像图特征。回顾性分析纳入患者的临床资料以及X线平片、CT、MRI检查的影像学资料,比较超声检查与其他影像检查的敏感度。结果超声检查诊断血肿20例,脓肿5例,假性动脉瘤5例,骨化性肌炎3例,骨肿瘤复发15例,周围神经损伤12例。超声诊断对内植物植入术后周围软组织病变的敏感度、特异度、准确度分别为89.4%、75.0%、88.6%,明显高于X线、CT、MRI检查(χ2=78.642、46.596、61.371,P<0.01)。血肿为边界清楚、内部回声均匀的低至无回声区。脓肿为囊实性混合回声,囊腔内脓液点状回声可浮动,彩色多普勒显像示中心区无血流信号。假性动脉瘤表现为动脉周围囊性包块,囊内血流旋转流动,颈部可探及典型的双期双向频谱信号。骨化性肌炎表现为肌肉内出现不规则的强回声伴声影。骨肿瘤复发时可见低回声软组织肿块,肿块内多可探及血流信号,出现虫蚀样骨质破坏。外周神经损伤时可致神经肿胀增粗、回声减低。结论超声检查在对金属内植物植入术后的软组织等结构观察中有较高的准确性,可作为首选方法。Purpose Artifacts of metal implantation severely affect image quality of CT or MRI examination, which restricts the display of local soft tissue lesions after orthopaedic surgery. This study aims to explore the application value of ultrasound examination in local soft tissue lesions after metal implant surgery. Materials and Methods Seventy patients with metal implantation after various orthopedic surgeries received US examination, and such sonographic features were recorded as lesion morphology, size, internal echo, edge, with/without capsule and calcification, and blood flow. Moreover, the clinical and radiologic data of patients like X-ray, CT and MRI were compared with the US results so as to determine the sensitivity of ultrasonic examination. Results The peripheral nerve injury might lead to thickened swelling and echo reduction. Ultrasonography revealed 20 cases of hematoma formation, 5 cases of abscess, 5 cases of pseudoaneurysm, 3 cases of myositis ossificans, 15 cases of bone tumor recurrence and 12 cases of peripheral nerve injury in operative region. Compared with the clinical results, the sensitivity, specificity and accuracy of ultrasound diagnosis of the study reached 89.4%, 75.0% and 88.6%, respectively, which were significantly higher than those of X-ray, CT and MRI（χ^2=78.642, 46.596 and 61.371, P〈0.01）. The ultrasonic results showed that most hematomas had clear boundary with homogenous echo inside to echofree zone. Abscesses mostly displayed cystic or hybrid echo with floatable intracavitary ＂pus spots＂ echo, and no blood flow signal existed in the central area of color Doppler. Pseudoaneurysm in the US showed cystic mass around artery, blood flow rotating in capsule, and the typical two-stage bi-spectrum signal in the neck of capsule. Myositis ossificans showed intramuscular irregular hyperecho with acoustic shadow. When bone tumor recurred, US showed hypoechoic soft tissue mass with moth-eaten bone destruction, and blood flow signals within the mass were often detected. Conclusion

关 键 词：骨疾病 假体和植入物 超声检查 多普勒 彩色 血肿 脓肿 动脉瘤 假性 肌炎 骨化性 肿瘤复发 局部 神经损伤 

分 类 号：R445.1[医药卫生—影像医学与核医学] R681[医药卫生—诊断学]