Huppertz Alexander, Radmer Sebastian, Wagner Moritz, Roessler Torsten, Hamm Bernd, Sparmann Martin
Department of Radiology, Charité-University Hospitals Berlin, Charitéplatz 1, 10117, Berlin, Germany,
Skeletal Radiol. 2014 Aug;43(8):1041-51. doi: 10.1007/s00256-014-1853-2. Epub 2014 Mar 13.
The number of total hip arthroplasties is continuously rising. Although less invasive surgical techniques, sophisticated component design, and intraoperative navigation techniques have been introduced, the rate of peri- and postoperative complications, including dislocations, fractures, nerve palsies, and infections, is still a major clinical problem. Better patient outcome, faster recovery and rehabilitation, and shorter operation times therefore remain to be accomplished. A promising strategy is to use minimally invasive techniques in conjunction with modular implants, aimed at independently reconstructing femoral offset and leg length on the basis of highly accurate preoperative planning. Plain radiographs have clear limitations for the correct estimation of hip joint geometry and bone quality. Three-dimensional assessment based on computed tomography (CT) allows optimizing the choice and positions of implants and anticipating difficulties to be encountered during surgery. Postoperative CT is used to monitor operative translation and plays a role in arthroplastic quality management. Radiologists should be familiar with the needs of orthopedic surgeons in terms of CT acquisition, post-processing, and data transfer. The CT protocol should be optimized to enhance image quality and reduce radiation exposure. When dedicated orthopedic CT protocols and state-of-the-art scanner hardware are used, radiation exposure can be decreased to a level just marginally higher than that of conventional preoperative radiography. Surgeons and radiologists should use similar terminology to avoid misunderstanding and inaccuracies in the transfer of preoperative planning.
全髋关节置换术的数量在持续上升。尽管已引入了侵入性较小的手术技术、先进的假体设计以及术中导航技术，但围手术期和术后并发症的发生率，包括脱位、骨折、神经麻痹和感染，仍然是一个主要的临床问题。因此，实现更好的患者预后、更快的恢复和康复以及更短的手术时间仍有待完成。一个有前景的策略是将微创技术与模块化植入物结合使用，旨在基于高度精确的术前规划独立重建股骨偏心距和肢体长度。普通X线片在正确评估髋关节几何形状和骨质方面有明显局限性。基于计算机断层扫描（CT）的三维评估有助于优化植入物的选择和位置，并预测手术中可能遇到的困难。术后CT用于监测手术移位情况，并在关节置换质量管理中发挥作用。放射科医生应在CT采集、后处理和数据传输方面熟悉骨科医生的需求。CT协议应进行优化，以提高图像质量并减少辐射暴露。当使用专门的骨科CT协议和最先进的扫描仪硬件时，辐射暴露可降低到仅略高于传统术前X线摄影的水平。外科医生和放射科医生应使用相似的术语，以避免术前规划传递中的误解和不准确。
