Egawa Hiroshi, Powers Cara C, Beykirch Sarah E, Hopper Robert H, Engh C Anderson, Engh Charles A
Anderson Orthopaedic Research Institute, Alexandria, VA 22307, USA.
Clin Orthop Relat Res. 2009 Jan;467(1):181-7. doi: 10.1007/s11999-008-0522-y. Epub 2008 Sep 27.
The most common method to diagnose and monitor osteolysis is the standard anteroposterior radiograph. Unfortunately, plain radiographs underestimate the incidence and extent of osteolysis. CT scans are more sensitive and accurate but also more expensive and subject patients to more radiation. To determine whether the volume of pelvic osteolysis could be accurately estimated without a CT scan, we evaluated the relationships between CT volume measurements and other variables that may be related to the size of pelvic osteolytic lesions in 78 THAs. Only the area of pelvic osteolysis measured on radiographs, heavy patient activity level, and total volume of wear were associated with the pelvic osteolysis volume measured on CT in the context of the multivariate regression analysis. Despite a strong correlation (r = 0.93, r(2) = 0.87) between these three variables and the volume of pelvic osteolysis measured on CT, estimates of pelvic osteolysis volume deviated from the actual volume measured on CT by more than 10 cm(3) among eight of the 78 THAs in this study. CT images remain our preferred modality when accurate assessments of pelvic osteolysis volume are required.
Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
诊断和监测骨溶解最常用的方法是标准前后位X线片。不幸的是，普通X线片会低估骨溶解的发生率和范围。CT扫描更敏感、准确，但费用更高，且使患者接受更多辐射。为了确定在不进行CT扫描的情况下能否准确估计骨盆骨溶解的体积，我们评估了78例全髋关节置换术（THA）中CT体积测量值与其他可能与骨盆溶骨性病变大小相关的变量之间的关系。在多变量回归分析中，仅X线片上测量的骨盆骨溶解面积、患者活动量大以及磨损总体积与CT测量的骨盆骨溶解体积相关。尽管这三个变量与CT测量的骨盆骨溶解体积之间存在强相关性（r = 0.93，r² = 0.87），但在本研究的78例THA中有8例，骨盆骨溶解体积的估计值与CT测量的实际体积偏差超过10 cm³。当需要准确评估骨盆骨溶解体积时，CT图像仍然是我们首选的检查方式。
III级，诊断性研究。有关证据水平的完整描述，请参阅作者指南。
