Swan J S, Braunstein E M, Wellman H N, Capello W
Department of Radiology, Indiana University Medical Center, Indianapolis.
Skeletal Radiol. 1991;20(1):15-9. doi: 10.1007/BF00243715.
The recent popularity of ingrowth or uncemented hip arthroplasties has presented problems in the radiographic diagnosis of loosening because there is no longer a cement interface in which lucencies may be seen. We evaluated a combination of positive contrast and nuclear arthrography to see whether these studies could accurately detect loosening of uncemented femoral components of hip prostheses. We performed routine contrast and nuclear arthrography in 21 patients with ingrowth total hip arthroplasties or bipolar endoprostheses. The results were surgically confirmed in 12 patients. The contrast arthrogram was true positive in 5 and false negative in 5. There were no false positives and 2 true negatives. The nuclear arthrogram was true positive in 7 patients, false negative in 3, and true negative in 2. Taken together, there was only 1 patient in whom both contrast and nuclear arthrography were false negative, and there were no false positives. Thus, when either contrast or nuclear arthrography is positive, the sensitivity of the combined procedures is 90%; when both studies are negative, the specificity is 100%. The combination of contrast and nuclear arthrography is an accurate method of determining loosening of the femoral component of an uncemented hip arthroplasty or bipolar endoprosthesis in the patient with postoperative hip pain.
近年来，骨长入型或非骨水泥型髋关节置换术日益普及，这给假体松动的影像学诊断带来了问题，因为不再存在能观察到透亮区的骨水泥界面。我们评估了阳性对比剂关节造影和核素关节造影相结合的方法，以确定这些检查能否准确检测非骨水泥型髋关节假体股骨部件的松动情况。我们对21例接受骨长入型全髋关节置换术或双极假体置换术的患者进行了常规对比剂关节造影和核素关节造影检查。其中12例患者的结果经手术证实。对比剂关节造影真阳性5例，假阴性5例。无假阳性，真阴性2例。核素关节造影真阳性7例，假阴性3例，真阴性2例。综合来看，对比剂关节造影和核素关节造影均为假阴性的仅1例患者，无假阳性。因此，当对比剂关节造影或核素关节造影任一项为阳性时，联合检查的敏感性为90%；当两项检查均为阴性时，特异性为100%。对于术后髋关节疼痛的患者，对比剂关节造影和核素关节造影相结合是确定非骨水泥型髋关节置换术或双极假体股骨部件松动的准确方法。
