全髋关节置换术后并发症的磁共振成像评估  

Evaluation of complications after total hip arthroplasty by magnetic resonance imaging

作　　者：金毅[1] 高宗炎[1] 郑稼[1] 陈骁[1] 代志鹏[1] 强硕[1] 关舒元[2] 李强 JIN Yi;GAO Zongyan;ZHENG Jia;CHEN Xiao;DAI Zhipeng;QIANG Shuo;GUAN Shuyuan;LI Qiang(Department of Orthopedics,Henan Provincial People's Hospital,Zhengzhou 450003,China;Department of Medical Imaging,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院骨科,郑州450003 [2]河南省人民医院影像科,郑州450003

出　　处：《中华骨与关节外科杂志》2019年第10期777-781,共5页Chinese Journal of Bone and Joint Surgery

基　　金：河南省科技攻关项目（172102310203,162102310300）

摘　　要：背景:传统影像学检查(X线片、CT、放射性核素扫描)评估全髋关节置换(THA)术后并发症的敏感性不理想,磁共振成像(MRI)具有软组织分辨率高、三维断层扫描等优势,随着去伪影技术的发展,使其在THA术后并发症的诊断中发挥重要作用。目的:探讨THA术后并发症进行MRI评估的影像特点。方法:回顾性分析2016年1月至2018年5月收治的因初次THA术后出现不适症状而就诊的46例患者,均为单侧,男25例,女21例;年龄36~85岁,平均(63.2±8.3)岁;初次THA到此次就诊时间为15~58个月,平均(30.3±17.2)个月。收集患者的病史,初次THA术前X线片、CT、放射性核素扫描、实验室检查,术后随访X线片、MRI,以及其中35例进行翻修术患者的术中所见、术后病理及细菌培养结果。从假体位置、假体-骨假界面、关节囊、关节周围软组织及病理组织等方面总结MRI特点。结果:46例患者复查MRI发现,其中36例中假体周围并发症包括骨溶解19例、无菌性松动15例、感染11例、假体周围骨折4例、假瘤4例,同时证实假体稳定患者11例。结论:使用金属伪影控制技术的MRI有利于对假体位置、稳定性、周围骨及软组织情况进行评估,早期发现多种术后并发症,评估病变范围,对于THA术后并发症的评估具有重要价值。Background: The traditional imaging examinations such as CT, X-ray and radionuclide scanning still do not have quite high sensibility for complications evaluation after total hip arthroplasty(THA). Magnetic resonance imaging(MRI) has the advantages of high resolution of soft tissue and three-dimensional tomography, and especially with the development of metal artifacts elimination technology in recent years, MRI has played an important role in the diagnosis of complications after THA. Objective: To evaluate the MRI findings of complications after total hip arthroplasty. Methods: From January 2016 to May 2018, data of 46 patients admitted in our hospital due to discomfort after primary unilateral THA including 25 males and21 females with the mean age of(63.2±8.3) years(range, 36-85 years) were retrospectively analyzed. The time from primary THA to this admission was(30.3±17.2) months in average(range, 15-58 months). The medical history, preoperative results of X-ray of primary THA, CT, radionuclide scan and laboratory test, postoperative results of X-ray and MRI, intraoperative findings in revision surgery of 35 patients and postoperative pathology and bacterial culture were collected and analyzed. The characteristics of MRI were summarized from such aspects as prosthesis position, prosthesis-bone interface, joint capsule, surrounding soft tissues and pathological tissues. Results: MRI examinations of 46 patients after the operation showed that periprosthetic complications in 36 patients included osteolysis(19 patients), aseptic loosening(15 patients), infection(11 patients),periprosthetic fracture(4 patients) and pseudotumor(4 patients), and the prostheses in 11 patients were stable. Conclusions:MRI using metal artifact control technique is helpful to evaluate the position and stability of the prosthesis and surrounding bone and soft tissue, to early detect postoperative complications, and to evaluate lesion range, which is of great value for the diagnosis and evaluation of complications.

关 键 词：全髋关节置换 术后并发症 磁共振成像 

分 类 号：R687.4[医药卫生—骨科学]