多层螺旋CT鉴别全髋关节置换术后迟发性无菌及感染性并发症  

The value of multidetector CT in differentiating delayed aseptic and infectious complications after total hip arthroplasty

作　　者：曾懿 张德洲[1] 易雪冰[1] ZENG Yi;ZHANG De-zhou;YI Xue-bing(Department of Radiology,Si Chuan Provincial Orthopedics Hospital,Chengdu 610041,China)

机构地区：[1]四川省骨科医院医学影像科,成都610041

出　　处：《放射学实践》2021年第2期232-237,共6页Radiologic Practice

基　　金：成都中医药大学科技发展基金(YYZX1621)。

摘　　要：目的:全髋关节置换术后迟发性无菌性并发症和感染性并发症的鉴别对于合理的手术计划和及时的抗菌治疗至关重要。本研究目的是探讨多层螺旋CT在诊断翻修术前全髋关节置换术患者无菌性机械松动、肉芽肿病和假体周围感染应用价值。方法:8年内共83例疑似假体周围并发症患者接受翻修手术,所有患者术前均行多层螺旋CT扫描。两位肌骨放射科医师采用盲法回顾了多层螺旋CT图像,包括假体周围软组织异常、假体髋臼错位、假体周围骨溶解、异位骨化和增大的髂淋巴结。采用多变量分析判断无菌性和感染性松动危险因素。结果:与假体周围感染独立相关多层螺旋CT征象为假体周围软组织重度异常[OR=11.94(1.49~95.63),P=0.019]、假体周围骨溶解而无膨胀性骨膜反应[OR=5.04(1.03~24.71),P=0.046]、髂淋巴结肿大[OR=1.71(4.56~64.10),P=0.000]。无以下放射学征象:假体周围软组织轻度或重度异常[OR=0.05(0.01~0.25),P=0.000;OR=0.05(0.01~0.17),P=0.000]、假体周围轻度或重度骨溶解[OR=0.16(0.05~0.55),P=0.03;OR=0.04(0.01~0.18),P=0.000]、髂淋巴结肿大[OR=0.15(0.05~0.47),P=0.001]是无菌性机械松动先兆。假体周围软组织轻度异常[OR=9.17(2.01~41.80),P=0.004]、假体周围重度骨溶解伴膨胀性骨膜反应[OR=35.5(4.18~302.4),P=0.001]、轻度假体髋臼错位[OR=3.41(1.17~9.96),P=0.025]是与肉芽肿病相关重要征象。结论:多层螺旋CT征象有助于在翻修手术前区分无菌性并发症和感染性并发症。假体周围骨溶解合并膨胀性骨膜反应似乎与全髋关节置换术后时间长短具有相关性。Objective:The differentiation between delayed aseptic and infectious complications of total hip arthroplasty is very important for rational surgical planning and prompt antimicrobial treatment.The purpose of this study was to evaluate the value of multidetector computed tomography(CT)findings in the diagnosis of aseptic mechanical loosening,granulomatous reaction and periprosthetic joint infection in patients who underwent total hip replacement before revision surgery.Methods:Over an 8 year-period,a total of 83 patients with clinically suspected periprosthetic complications received revision surgery,all of whom received preoperative multidetector CT without contrast media.Two musculoskeletal radiologists performed a blind review of CT images,including the periprosthetic soft tissue abnormalities,prosthetic acetabular malposition,periprosthetic osteolysis,ectopic ossification,and enlarged iliac lymph nodes.Multivariate analysis was used to determine the risk factors for asepsis and infectious loosening.Results:The multidetector CT variables independently related to the infection around the prosthesis were abnormality of the periprosthetic soft-tissue[OR=11.94(1.49~95.63),P=0.019],periprosthetic osteolysis without expansile periosteal reaction[OR=5.04(1.03~24.71),P=0.046],and iliac lymph node enlargement[OR=1.71(4.56~64.10),P=0.000].In contrast,the absence of the following radiological signs:mild or severe abnormality of the periprosthetic soft-tissue[OR=0.05(0.01~0.25),P=0.000;OR=0.05(0.01~0.17),P=0.000],mild or severe periprosthetic osteolysis[OR=0.16(0.05~0.55),P=0.03;OR=0.04(0.01~0.18),P=0.000],and iliac lymph node enlargement[OR=0.15(0.05~0.47),P=0.001],were precursors to aseptic mechanical loosening.Mild abnormality of the periprosthetic soft-tissue[OR=9.17(2.01~41.80),P=0.004],severe periprosthetic osteolysis with expansile periosteal reaction[OR=35.5(4.18~302.4),P=0.001],and mild acetabular malposition[OR=3.41(1.17~9.96),P=0.025]were significant variables associated with granulomatosis.Conclusion:Multidetec

关 键 词：体层摄影术 X线计算机 关节成形术 置换 髋 手术后并发症 伤口感染 

分 类 号：R814.4[医药卫生—影像医学与核医学] R687.42[医药卫生—放射医学]