Long Island Jewish Medical Center, Northwell Health, New York, New York.
Department of Orthopaedic Surgery, Adult Reconstruction, The CORE Institute, Phoenix, Arizona.
J Knee Surg. 2021 Oct;34(12):1296-1303. doi: 10.1055/s-0040-1708041. Epub 2020 Apr 8.
This review investigated the potential value of computed tomography (CT) scans for the evaluation and management of knee arthritis and arthroplasty. Specifically, we evaluated the following: (1) assessment of arthritis within knee compartments, (2) patellofemoral joint assessment, (3) implant sizing prediction, (4) component alignment, (5) soft-tissue protection, and (6) potential concerns with radiation exposure. To compare if CT or X-ray imaging is more accurate and clinically relevant, a search was performed using Boolean search operators and terms: "CT," "radiograph," "joint alignment," "knee," and "arthroplasty," which yielded 661 results. Studies were evaluated based on (1) assessment of arthritis within knee compartments, (2) patellofemoral joint assessment, (3) implant sizing prediction, (4) component alignment, (5) soft-tissue protection, and (6) potential concerns with radiation exposure. Correlative and comparative analyses of imaging modalities to pre-, intra-, and postoperative clinical and patient-related factors were performed for the 63 included studies. CT scans were found to better detect medial and lateral arthritic changes, bony deformities, subchondral cysts, and cartilage losses. CT scans were shown to 99% accurately predict prosthetic sizes preoperatively. CT scans can also help better visualize surrounding anatomy, such as the posterior cruciate ligament, and have therefore been linked to better soft tissue protection during total knee arthroplasty. Although radiation is a potential concern, newer imaging protocols have comparable exposure to plain radiographs. Compared with plain radiographs, CT scans were found to be more accurate and provide more clinically relevant data. Therefore, the authors recommend the use of CT for the evaluation of certain patients with arthritis and for preoperative planning for knee arthroplasty.
本文回顾了计算机断层扫描（CT）在膝关节关节炎和关节置换评估和管理中的潜在价值。具体来说，我们评估了以下内容：（1）膝关节各间室关节炎的评估；（2）髌股关节评估；（3）植入物尺寸预测；（4）部件对齐；（5）软组织保护；（6）与辐射暴露相关的潜在问题。为了比较 CT 或 X 射线成像更准确和更具临床相关性，我们使用布尔搜索运算符和术语进行了搜索：“CT”、“射线照相”、“关节对齐”、“膝关节”和“关节置换”，共得到 661 项结果。研究根据以下标准进行评估：（1）膝关节各间室关节炎的评估；（2）髌股关节评估；（3）植入物尺寸预测；（4）部件对齐；（5）软组织保护；（6）与辐射暴露相关的潜在问题。对 63 项纳入研究进行了影像学检查与术前、术中及术后临床和患者相关因素的相关和比较分析。CT 扫描能更好地检测内侧和外侧关节炎变化、骨畸形、软骨下囊肿和软骨损失。CT 扫描可 99%准确预测术前假体尺寸。CT 扫描还可以帮助更好地显示周围解剖结构，如后交叉韧带，因此与全膝关节置换术期间更好的软组织保护相关。尽管辐射是一个潜在的问题，但新的成像方案与普通射线照相具有可比的辐射暴露。与普通射线照相相比，CT 扫描更准确，提供更具临床相关性的数据。因此，作者建议在某些关节炎患者的评估和膝关节置换术前规划中使用 CT。
