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全髋关节置换术(total hip arthroplasty,THA)在20世纪60年代初期由英国整形外科医生约翰·查恩利开创。随着医学技术的发展以及假体材料的改进与完善,到目前为止,人工假体的10年生存率已达90%以上。但THA后8年,3.94%的患者会出现术后并发症并需做翻修手术[1]。无菌性松动、脱位或半脱位、感染、疼痛和假体周围骨折是最常见的并发症,而感染、骨质疏松、骨吸收等是造成假体(髋臼或股骨柄)松动甚至假体断裂的直接原因[2-3]。因此,采用合适的影像诊断技术对术后并发症进行准确的评估具有重要意义。
螺旋CT扫描具有较高的密度分辨率,可清晰地显示细微骨性结构,其三维重建图像具有更直观、更准确的优点。多排螺旋CT的多平面重建技术可以多方位、多角度显示骨质结构。由于髋关节解剖结构较为复杂且THA后髋臼杯被金属球头遮挡,X线平片前后重叠的二维图像无论图像清晰度还是测量精确度均不及CT检查。关节置换后使用螺旋CT扫描可用于评估股骨假体旋转对线情况[4]。
SPECT显像具有显示假体周围骨代谢活动的优势,且不会因金属假体的影响而造成显像质量的下降。SPECT/CT融合了二者的优势,提供了比传统X线更为优越的空间定位,是THA后诊断和处理并发症的重要依据。本文对髋关节置换术后正常的和常见并发症的SPECT/CT影像特点进行逐一阐述。
SPECT/CT对全髋关节置换术后并发症的诊断价值
Diagnostic value of complications after total hip replacement by SPECT/CT
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摘要: 关节置换手术后,假体松动及感染等并发症是患者术后不适的主要原因。在正确判断并发症方面,传统的影像手段各有利弊。SPECT/CT将功能成像与解剖成像同机融合,可以明确全髋关节置换术(THA)后金属假体与邻近骨质情况,判断术后并发症的出现,有助于手术方案的制定。笔者对CT三维影像测量在髋关节数据测量精确性方面的优势、方法和髋关节置换术后常见并发症,包括无菌性松动、假体周围感染、组织细胞反应、假体周围骨折、聚乙烯内衬磨损、异位骨化、假体周围假瘤形成等SPECT/CT影像特点做一综述。
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关键词:
- 关节成形术, 置换, 髋 /
- 手术后并发症 /
- 体层摄影术, 发射型计算机, 单光子 /
- 体层摄影术, X线计算机
Abstract: With the improvement of economic level, the requirement to achieve quality of life is increased. An increasing number of individuals are undergoing joint replacement surgery due to femoral neck fracture, traumatic arthritis, and femoral head necrosis. Prosthesis loosening and complications, such as infection, causes post-operative discomfort among patients. Traditional imaging for evaluating the existence of complications has advantages and disadvantages. Thus, single-photon emission computed tomography (SPECT) is combined with spiral CT scanning. Fusing functional imaging and anatomical imaging significantly improves diagnostic accuracy. SPECT imaging has shown its advantage in terms of implant surrounding bone metabolic activity. This technique retains high image quality regardless of the presence of metal prosthesis. Moreover, spiral CT improves anatomical detail display in SPECT imaging. This review explores 3D CT imaging data on hip measurement accuracy, advantages, and methods, as well as SPECT and CT imaging features on the common complications after total hip arthroplasty. These complications include infection around the implant, aseptic loosening tissue reaction, prosthesis peripheral fracture, polyethylene liner wear, heterotopic ossification, and prosthesis pseudotumor formation. -
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