透视引导下急性脱位全髋关节置换术的抽吸：一种可行、高收益且安全的手术。

Fluoroscopy-guided aspiration of the acutely dislocated total hip arthroplasty: a feasible, high-yield, and safe procedure.

作者信息

Flores Dyan V, Felemban Abdullah, Hodgdon Taryn, Beaulé Paul, Grammatopoulos George, Rakhra Kawan S

机构信息

Department of Radiology, Radiation Oncology and Medical Physics Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada.

出版信息

Insights Imaging. 2025 Jan 10;16(1):9. doi: 10.1186/s13244-024-01880-9.

DOI:10.1186/s13244-024-01880-9

PMID:39792214

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11723859/

Abstract

OBJECTIVE

To determine the feasibility, yield, and safety of fluoroscopic-guided aspiration of the acutely dislocated total hip arthroplasty (AD-THA).

MATERIALS AND METHODS

IRB-approved, retrospective review of fluoroscopic-guided aspirations of AD-THA (January 2005-December 2023) was performed. Data from electronic charts and fluoroscopy images/reports were obtained. Positive yield was defined as spontaneous aspirate or saline rinse adequate for microbiology analysis. Sub-analysis by needle target (acetabular cup or femur) was performed for spontaneous aspiration rate, aspirate volume and fluoroscopy time. Differences between groups were analyzed with unpaired, t-test (2-tail) and between proportions with Fisher's exact test, with significance p < 0.05.

RESULTS

Aspiration of 20 AD-THA in 19 patients (12 female, mean age (SD) of 73 years (16)) targeted the acetabular cup in 45% (9/20) or femur in 55% (11/20) of cases. Positive yield was obtained in 95% (19/20), with spontaneous aspirate in 75% (15/20) and saline rinse in 20% (4/20) of cases; in 5% (1/20), no diagnostic sample was obtained. Spontaneous aspirate mean volume (SD, range) for all cases was 8.3 mL (6.9, 0.2-25), and higher when targeting the acetabular cup 11.2 mL (6.9, 5-25) versus the femur 4.0 mL (4.4, 0.2-12) (p = 0.026). The rate of spontaneous aspiration was higher for the acetabular cup 100% (9/9) versus the femur 55% (6/11) (p = 0.038). The mean fluoroscopy time (SD, range) for all cases was 43 s (25, 19-102), and shorter for targeting the acetabular cup 32 s (16, 19-75) versus the femur 56 s (28, 28-102) (p = 0.034). No immediate complications occurred in all aspirations.

CONCLUSION

Fluoroscopy-guided aspiration of AD-THA is a feasible, high-yield, and safe procedure. Targeting the acetabular cup results in a higher rate of spontaneous aspirate, larger aspiration volume, and lower fluoroscopy time.

CRITICAL RELEVANCE STATEMENT

Although technically more challenging, radiologists should feel confident aspirating the acutely dislocated total hip arthroplasty (AD-THA) under fluoroscopic guidance.

KEY POINTS

Total hip arthroplasty (THA) infection can be evaluated with synovial fluid aspiration. Fluoroscopic-guided aspiration of the dislocated THA is feasible, high-yield, and safe. Targeting of the acetabular cup is recommended over the femoral prosthetic component. Acetabular cup targeting gives larger, spontaneous aspirates with lower fluoroscopy time.

摘要

目的

确定在透视引导下对急性脱位全髋关节置换术（AD-THA）进行穿刺抽吸的可行性、成功率及安全性。

材料与方法

对2005年1月至2023年12月期间在透视引导下对AD-THA进行穿刺抽吸的病例进行了经机构审查委员会批准的回顾性研究。获取了电子病历以及透视图像/报告中的数据。阳性抽吸结果定义为获取的自然抽吸液或用于微生物学分析的盐水冲洗液足够。针对自然抽吸率、抽吸液量及透视时间，按穿刺针靶点（髋臼杯或股骨）进行了亚组分析。组间差异采用非配对双尾t检验进行分析，比例间差异采用Fisher精确检验进行分析，显著性水平为p < 0.05。

结果

19例患者的20例AD-THA进行了穿刺抽吸，其中女性12例，平均年龄（标准差）为73岁（16岁）。45%（9/20）的病例穿刺靶点为髋臼杯，55%（11/20）的病例穿刺靶点为股骨。95%（19/20）的病例获得了阳性抽吸结果，其中75%（15/20）的病例为自然抽吸，20%（4/20）的病例为盐水冲洗；5%（1/20）的病例未获得诊断性样本。所有病例自然抽吸液的平均量（标准差，范围）为8.3 mL（6.9，0.2 - 25），穿刺靶点为髋臼杯时更高，为11.2 mL（6.9，5 - 25），而穿刺靶点为股骨时为4.0 mL（4.4，0.2 - 12）（p = 0.026）。髋臼杯的自然抽吸率更高，为100%（9/9），而股骨为55%（6/11）（p = 0.038）。所有病例的平均透视时间（标准差，范围）为43秒（25，19 - 102），穿刺靶点为髋臼杯时更短，为32秒（16，19 - 75），而穿刺靶点为股骨时为56秒（28，28 - 102）（p = 0.034）。所有穿刺抽吸均未发生即刻并发症。