Płomiński Janusz, Kwiatkowski Krzysztof, Zabicka Magda
Military Institute of the Health Service, Department of Orthopeadics, Central Clinical Hospital of the Ministry of National Defence,Warsaw, Poland.
Pol Merkur Lekarski. 2006 Dec;21(126):540-3.
The aim of the study was assessment, on the basis of computed tomography (CT) examination, of remodelling of compacted frozen bone sliver grafts used in acetabular revision arthroplasty.
The study involved ten patients treated in the years 1998-2000 for aseptic loosening of hip joint prosthesis elements. Eight women and two men were studied. The mean age of the patients was 69.6 years (from 52 to 74 years). The mean time between primary and revision arthroplasty was 6.8 years. Spiral CT examination was performed 6 weeks and 3, 6, 12, 24, 36 months after the operation. Density measurement was done using ROI (region of interest) function including spongy bone area from 50 to 80 mm2. The studied layer thickness was 3.2 mm. In the examination both hip joints were assessed, accepting the joint not operated on as standard for a given patient. The measurement was done in six zones according to DeLee, Charnley.
Progressing reduction of graft density was found in relation to healthy bone density. During the first three months most rapid density reduction was observed in all patients. The lowest density decrease was seen in the postero-superior part of the acetabulum while the highest density reduction occurred in the lower part. Trabeculation change was observed from that resembling compact bony tissue to that corresponding to spongy tissue. In two patients after six months a significant graft density reduction occurred both in the lower and upper parts of the acetabulum. In these patients acetabular loosening was confirmed, requiring reoperation.
CT examination of bone density makes possible quantitative assessment of bone graft remodelling and qualitative assessment imaging the structure of the grafts. The non-invasive method of CT examination of bone graft density allows for prognostication as to stability of the seated acetabulum.
本研究旨在基于计算机断层扫描（CT）检查，评估用于髋臼翻修置换术中的压实冷冻骨条移植骨的重塑情况。
本研究纳入了1998年至2000年间因髋关节假体无菌性松动而接受治疗的10例患者。其中8例女性，2例男性。患者的平均年龄为69.6岁（52岁至74岁）。初次置换与翻修置换之间的平均时间为6.8年。术后6周以及3、6、12、24、36个月进行螺旋CT检查。使用感兴趣区域（ROI）功能进行密度测量，包括50至80平方毫米的松质骨区域。所研究的层面厚度为3.2毫米。在检查中对双侧髋关节进行评估，将未手术的关节作为该特定患者的对照标准。根据DeLee、Charnley法在六个区域进行测量。
与健康骨密度相比，移植骨密度逐渐降低。在最初三个月内，所有患者均观察到密度下降最为迅速。髋臼后上部的密度下降最少，而下部的密度下降最大。观察到骨小梁结构从类似致密骨组织转变为对应于松质组织的结构。有两名患者在六个月后髋臼上下部均出现明显的移植骨密度降低。在这些患者中证实存在髋臼松动，需要再次手术。
对骨密度进行CT检查能够对骨移植重塑进行定量评估，并对移植骨结构进行定性评估成像。CT检查骨移植密度的非侵入性方法有助于预测髋臼假体的稳定性。
