Foley M, Maslack M M, Rothman R H, Casey M P, Lugano E M, Parry C E, Balderston R A, Booth R E
Department of Radiology, Pennsylvania Hospital, Philadelphia 19107.
Radiology. 1989 Aug;172(2):481-5. doi: 10.1148/radiology.172.2.2748830.
Serial pulmonary imaging has proved to be effective in the evaluation of patients undergoing total joint arthroplasty. A clinical dilemma arises in asymptomatic patients whose postoperative pulmonary images differ from the preoperative images. The authors prospectively evaluated 403 patients with serial imaging to determine the significance of changed postoperative images in asymptomatic patients undergoing total hip or knee arthroplasty. Twenty-two (5.5%) patients had significant changes on postoperative images. Seventeen were asymptomatic; all but one underwent pulmonary angiography. Documented pulmonary emboli were demonstrated in 100% of patients whose postoperative images changed to indicate a high probability of pulmonary embolism, 71% whose images changed to a moderate probability, and 0% whose images changed to indeterminate probability. Overall, pulmonary emboli occurred in 76% of all asymptomatic patients with significantly change postoperative images. Asymptomatic pulmonary embolism is a significant occurrence after total hip or knee repair, and a changed lung scan with appropriate clinical evaluation is an accurate indicator of pulmonary emboli in asymptomatic postarthroplasty patients.
连续肺部成像已被证明在评估接受全关节置换术的患者时是有效的。对于术后肺部影像与术前影像不同的无症状患者，会出现临床困境。作者对403例患者进行了连续成像的前瞻性评估，以确定在接受全髋关节或膝关节置换术的无症状患者中术后影像改变的意义。22例（5.5%）患者术后影像有显著变化。17例无症状；除1例之外均接受了肺血管造影。术后影像改变提示肺栓塞高概率的患者中100%证实有肺栓塞，影像改变提示中度概率的患者中71%有肺栓塞，影像改变提示不确定概率的患者中0%有肺栓塞。总体而言，在所有术后影像有显著改变的无症状患者中，76%发生了肺栓塞。无症状肺栓塞在全髋关节或膝关节置换术后是一种重要情况，术后肺部扫描改变并结合适当的临床评估是无症状关节置换术后患者肺栓塞的准确指标。
