Horas K, Arnholdt J, Steinert A F, Hoberg M, Rudert M, Holzapfel B M
Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany.
Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, 4049, Brisbane, QLD, Australia.
Orthopade. 2017 Feb;46(2):168-178. doi: 10.1007/s00132-016-3378-y.
Parallel to the rising number of revision hip procedures, an increasing number of complex periprosthetic osseous defects can be expected. Stable long-term fixation of the revision implant remains the ultimate goal of the surgical protocol. Within this context, an elaborate preoperative planning process including anticipation of the periacetabular defect form and size and analysis of the remaining supporting osseous elements are essential. However, detection and evaluation of periacetabular bone defects using an unsystematic analysis of plain anteroposterior radiographs of the pelvis is in many cases difficult. Therefore, periacetabular bone defect classification schemes such as the Paprosky system have been introduced that use standardized radiographic criteria to better anticipate the intraoperative reality. Recent studies were able to demonstrate that larger defects are often underestimated when using the Paprosky classification and that the intra- and interobserver reliability of the system is low. This makes it hard to compare results in terms of defects being studied. Novel software tools that are based on the analysis of CT data may provide an opportunity to overcome the limitations of native radiographic defect analysis. In the following article we discuss potential benefits of these novel instruments against the background of the obvious limitations of the currently used native radiographic defect analysis.
随着髋关节翻修手术数量的不断增加，预计复杂的假体周围骨缺损数量也会日益增多。翻修植入物的长期稳定固定仍是手术方案的最终目标。在此背景下，精心的术前规划过程至关重要，这包括预估髋臼周围缺损的形态和大小以及分析剩余的支撑骨结构。然而，在许多情况下，通过对骨盆前后位平片进行非系统分析来检测和评估髋臼周围骨缺损是困难的。因此，已引入了诸如Paprosky系统之类的髋臼周围骨缺损分类方案，该方案使用标准化的影像学标准来更好地预估术中实际情况。最近的研究表明，使用Paprosky分类时，较大的缺损常常被低估，并且该系统在观察者内和观察者间的可靠性较低。这使得在研究缺损方面难以比较结果。基于CT数据分析的新型软件工具可能提供一个机会来克服传统影像学缺损分析的局限性。在接下来的文章中，我们将在当前使用的传统影像学缺损分析存在明显局限性的背景下，讨论这些新型工具的潜在益处。
