金属伪影减少序列磁共振成像在无症状陶瓷对聚乙烯全髋关节置换患者中的异常表现
Metal Artifact Reduction Sequence MRI Abnormalities in Asymptomatic Patients with a Ceramic-on-Polyethylene Total Hip Replacement.
作者信息
Jennings Jason M, Martin J Ryan, Kim Raymond H, Yang Charlie C, Miner Todd M, Dennis Douglas A
机构信息
1Colorado Joint Replacement, Denver, Colorado 2Department of Biomedical Engineering, University of Denver, Denver, Colorado 3Department of Orthopedic Surgery, Joan C. Edwards School of Medicine at Marshall University, Huntington, West Virginia 4Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado 5Department of Biomedical Engineering, University of Tennessee, Knoxville, Tennessee.
出版信息
J Bone Joint Surg Am. 2017 Apr 5;99(7):593-598. doi: 10.2106/JBJS.16.00910.
BACKGROUND
Magnetic resonance imaging (MRI) is a commonly utilized screening modality in patients with a metal-on-metal (MoM) total hip replacement. The prevalence of clinically important fluid collections may be overestimated since these collections have been reported to occur in asymptomatic patients with MoM and other bearing surfaces. The purpose of this study was to determine the frequency and types of MRI-documented adverse local tissue reactions in asymptomatic patients with a ceramic-on-polyethylene (CoP) total hip replacement.
METHODS
Forty-four patients (50 hips) with a minimum 2-year follow-up after total hip arthroplasty with CoP implants and a Harris hip score of >90 were enrolled in this study. The inclusion criteria were the absence of hip pain and the availability of appropriate follow-up radiographs. All patients underwent a metal artifact reduction sequence (MARS) MRI scan to determine the presence of fluid collections in asymptomatic patients with a CoP bearing surface.
RESULTS
Fluid collections were observed in 9 (18%) of 50 asymptomatic hips in this cohort. There were 5 hips with intracapsular synovitis, and 2 of these hips had a thickened synovium. Extra-articular fluid collections with direct intracapsular communication were identified in 4 additional hips. Two of these hips had a thickened synovium. No signs of osteolysis or evidence of adverse local tissue reactions were noted on radiographs at the most recent follow-up.
CONCLUSIONS
This study revealed that fluid collections are not uncommon after total hip arthroplasty with CoP implants. Synovial thickening may be present and is more prevalent than has been reported in previous studies involving metal-on-polyethylene (MoP) bearing surfaces. The clinical importance and natural history of these findings remain unknown.
LEVEL OF EVIDENCE
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景
磁共振成像（MRI）是金属对金属（MoM）全髋关节置换患者常用的筛查方式。临床上重要的积液患病率可能被高估了，因为据报道这些积液在MoM及其他关节面的无症状患者中也会出现。本研究的目的是确定陶瓷对聚乙烯（CoP）全髋关节置换无症状患者中MRI记录的不良局部组织反应的频率和类型。
方法
本研究纳入了44例患者（50髋），这些患者在接受CoP植入物全髋关节置换术后至少随访2年，且Harris髋关节评分>90分。纳入标准为无髋关节疼痛且有合适的随访X线片。所有患者均接受了金属伪影减少序列（MARS）MRI扫描，以确定CoP关节面无症状患者中是否存在积液。
结果
在该队列的50例无症状髋关节中，有9例（18%）观察到积液。有5髋存在关节内滑膜炎，其中2髋滑膜增厚。另外4髋发现有与关节内直接相通的关节外积液。其中2髋滑膜增厚。在最近一次随访的X线片上未发现骨溶解迹象或不良局部组织反应的证据。
结论
本研究表明，CoP植入物全髋关节置换术后积液并不少见。可能存在滑膜增厚，且比先前涉及金属对聚乙烯（MoP）关节面的研究报道更为普遍。这些发现的临床意义和自然病程仍不清楚。
证据水平
诊断性IV级。有关证据水平的完整描述，请参阅作者须知。
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