Kitamura Nobuto, Leung Serena B, Engh Charles A
Anderson Orthopaedic Research Institute, Alexandria, VA 22307, USA.
Clin Orthop Relat Res. 2005 Dec;441:291-7. doi: 10.1097/01.blo.0000192359.12573.15.
We investigated the characteristics of pelvic osteolysis using computed tomography to assess osteolytic patterns associated with five acetabular cup designs. Additionally, we examined the relationship between polyethylene wear and volume of pelvic osteolysis. We measured defect volume on the computed tomography images of 126 hips at a mean of 10.9 years after arthroplasty. Defects were classified as osteolysis if there was: (1) a well-defined sclerotic border, (2) no radiographic evidence that the defect existed before hip arthroplasty, and (3) a clear communication between the defect and the joint space. We identified 225 bone defects in 116 hips. Of these, 184 defects in 101 hips fulfilled our criteria for osteolysis. We found that lesion size and the location of the communication pathways depended on the cup design. Osteolysis occurred primarily through central holes, and occurred only around the rim if there were no holes in the cup. The lesions that communicated only through central holes and those with multiple communications tended to be larger than rim-related lesions. There was a moderate correlation between volumetric polyethylene wear and osteolysis volume. Communication pathways between lesions and the joint space are valuable for diagnosing osteolysis on computed tomography. Lesion volume, location, and type of communication pathway to the joint are influenced by cup design.
Therapeutic study, Level IV-1 (retrospective case series). See the Guidelines for Authors for a complete description of levels of evidence.
我们使用计算机断层扫描研究了骨盆骨质溶解的特征，以评估与五种髋臼杯设计相关的骨质溶解模式。此外，我们还研究了聚乙烯磨损与骨盆骨质溶解体积之间的关系。我们在平均关节置换术后10.9年时，测量了126例髋关节的计算机断层扫描图像上的缺损体积。如果存在以下情况，则将缺损归类为骨质溶解：（1）边界清晰的硬化边缘；（2）没有影像学证据表明该缺损在髋关节置换术前就已存在；（3）缺损与关节间隙之间有明显的连通。我们在116例髋关节中发现了225处骨缺损。其中，101例髋关节中的184处缺损符合我们的骨质溶解标准。我们发现病变大小和连通途径的位置取决于髋臼杯的设计。骨质溶解主要通过中心孔发生，如果髋臼杯上没有孔，则仅在边缘周围发生。仅通过中心孔连通的病变和具有多个连通的病变往往比与边缘相关的病变更大。聚乙烯磨损体积与骨质溶解体积之间存在中度相关性。病变与关节间隙之间的连通途径对于在计算机断层扫描上诊断骨质溶解很有价值。病变体积、位置以及与关节的连通途径类型受髋臼杯设计的影响。
治疗性研究，IV-1级（回顾性病例系列）。有关证据水平的完整描述，请参阅作者指南。
