Roh Y H, Yoo S J, Choi T H, Nam K W
Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju City, South Korea.
Department of Orthopaedic Surgery, Uijeongbu Eulji Medical Center, Uijeongbu, South Korea.
Malays Orthop J. 2023 Mar;17(1):124-132. doi: 10.5704/MOJ.2303.015.
Accurate diagnosis of undisplaced periprosthetic femoral fracture (PFF) after hip arthroplasty is crucial, as overlooked PFF may affect its treatment and prognosis. The undisplaced PFF is often difficult to distinguish from radiolucent lines of nutrient artery canal (NAC) of the femur present on post-operative radiographs. We aimed to identify the radiographic features of NAC to distinguish them from PFFs.
In this retrospective radiological study, a total of 242 cases in 215 patients with hip arthroplasty were analysed using pre-operative and post-operative anteroposterior (AP) and translateral (TL) radiographs. Interobserver agreement of the measurements was assessed by two independent experienced orthopaedic surgeons. The kappa value ranged from 0.83 to 0.87, indicating strong agreement according to the Landis and Koch criteria.
The NACs were found pre-operatively in 94 (39.8%) cases on AP views and in 122 cases (50.4%) on TL views. The radiolucent lines were observed post-operatively in 42 (17.4%) on AP views and 122 (50.4%) on the TL views. three cases (1.2%) had a fracture around the stem that were detected on radiographs. One case with PFF presented simultaneously with NAC on the immediate post-operative radiographs. All patients were treated by conservative measures, and the radiolucent lines did not appear on follow-up radiographs.
It is not easy to differentiate undisplaced PFFs that can occur after hip arthroplasty operation from NACs. However, accurate diagnosis is possible through careful observation and comparison of pre-operative and post-operative radiologic images.
准确诊断髋关节置换术后无移位的假体周围股骨骨折（PFF）至关重要，因为被忽视的PFF可能会影响其治疗和预后。无移位的PFF通常难以与术后X线片上出现的股骨滋养动脉管（NAC）的透亮线区分开来。我们旨在确定NAC的影像学特征，以将它们与PFF区分开来。
在这项回顾性放射学研究中，使用术前和术后的前后位（AP）和经侧位（TL）X线片分析了215例髋关节置换患者中的242例病例。由两名独立的经验丰富的骨科医生评估测量结果的观察者间一致性。kappa值范围为0.83至0.87，根据Landis和Koch标准表明有很强的一致性。
术前在AP位片上发现94例（39.8%）有NAC，在TL位片上发现122例（50.4%）。术后在AP位片上观察到42例（17.4%）有透亮线，在TL位片上观察到122例（50.4%）。3例（1.2%）在X线片上检测到假体柄周围有骨折。1例PFF患者在术后即刻X线片上同时出现NAC。所有患者均采用保守治疗，随访X线片上未出现透亮线。
区分髋关节置换术后可能出现的无移位PFF和NAC并不容易。然而，通过仔细观察和比较术前及术后的放射影像可以实现准确诊断。
