Kaplan P A, Montesi S A, Jardon O M, Gregory P R
Department of Radiology, University of Nebraska Medical Center, Omaha 68105.
Radiology. 1988 Oct;169(1):221-7. doi: 10.1148/radiology.169.1.3420262.
The radiographic changes of 85 bone-ingrowth femoral prostheses in 77 asymptomatic patients were reviewed. The average postoperative follow-up time was 21.8 months. In decreasing order of frequency, the alterations included (a) remodeling of the proximal medial edge of the cut femoral neck (stress shielding) (98%), (b) linear lucency with a thin sclerotic margin at the prosthesis-bone interface (that may increase in width or length with time) (79%), (c) endosteal sclerosis at the prosthesis tip (36%), (d) heterotopic bone (24%), (e) cortical thickening at the tip of the prosthesis (12%), (f) prosthetic subsidence (7%), (g) intraoperative fracture (7%), and (h) periosteal reaction (4%). In this study, radiographic evidence of these findings was not associated with clinical failure. This is in distinction to the findings in cemented prostheses, in which many of these phenomena (especially the development of increasing width of the lucent line adjacent to the cement or prosthesis) have been associated with failure. Long-term investigations of porous-coated prostheses are necessary. Currently, however, an awareness of the radiographic alterations that occur with asymptomatic bone-ingrowth prostheses can prevent their misinterpretation as abnormal.
回顾了77例无症状患者中85个骨长入型股骨假体的影像学变化。术后平均随访时间为21.8个月。按出现频率从高到低排序，这些改变包括：(a) 截骨股骨颈近端内侧边缘重塑（应力遮挡）(98%)；(b) 假体-骨界面处有薄硬化边缘的线性透亮区（其宽度或长度可能随时间增加）(79%)；(c) 假体尖端骨内膜硬化 (36%)；(d) 异位骨 (24%)；(e) 假体尖端皮质增厚 (12%)；(f) 假体下沉 (7%)；(g) 术中骨折 (7%)；以及(h) 骨膜反应 (4%)。在本研究中，这些发现的影像学证据与临床失败无关。这与骨水泥型假体的发现不同，在骨水泥型假体中，许多这些现象（尤其是靠近骨水泥或假体的透亮线宽度增加）与失败有关。有必要对多孔涂层假体进行长期研究。然而，目前了解无症状骨长入型假体出现的影像学改变可以防止将其误解为异常。
