Schneider R, Freiberger R H, Ghelman B, Ranawat C S
Clin Orthop Relat Res. 1982 Oct(170):156-68.
The most important method of evaluation of painful total joint prostheses is review of sequential radiographs. Because clinical failure from loosening occurs late, abnormalities of alignment, the cement-bone or cement-metal interface, the bony contour, or the integrity of the prosthetic components will be found in the vast majority of cases of clinical failure. In cases in which plain radiographs are normal or equivocal, radionuclide bone scanning with Tc-99m diphosphonate agents are useful. A diffuse increase in vascularity and in uptake of radionuclide is present in infection, while a normal scan suggests that infection or loosening is unlikely. Positive arthrograms are helpful in confirming loosening and in demonstrating abscess cavities and sinus tracts, but negative arthrograms have little significance. Asymptomatic patients with radiographic evidence of loosening should be followed with sequential roentgenograms for signs of progressive bone destruction.
评估疼痛性全关节假体最重要的方法是连续X线片复查。由于假体松动导致的临床失败出现较晚，在绝大多数临床失败病例中，会发现对线异常、骨水泥-骨或骨水泥-金属界面异常、骨轮廓异常或假体部件完整性受损。在X线平片正常或不明确的情况下，使用锝-99m二膦酸盐类药物进行放射性核素骨扫描很有用。感染时会出现血管增多和放射性核素摄取增加，而扫描结果正常提示感染或松动的可能性不大。阳性关节造影有助于确认假体松动并显示脓肿腔和窦道，但阴性关节造影意义不大。有假体松动影像学证据的无症状患者应定期进行X线检查，观察是否有进行性骨破坏的迹象。
