Nardis P, Bellelli A, Giannecchini S, Ghera S, Santori F S
Divisione di Radiologia, Ospedale Fatebenefratelli San Pietro, Roma.
Radiol Med. 1995 Oct;90(4):378-82.
In the last few years hip arthroplasty has been increasingly used and both metaphysis and diaphysis of the proximal femur are studied preoperatively for best compliance between prosthesis and bone. Indeed, the best results can be obtained by reducing the risk of stem end mobilization, which means to choose the prosthesis fitting the femoral canal best and to limit the use of cement prostheses, which are at high risk of mobilization in time, to advanced osteoporosis patients. We used a simple and repeatable CT technique to study femoral canal structure and size. After accurately positioning the patients inside the gantry, we acquired some axial scans at scheduled levels referring to the horizontal midline of the lesser trochanter. The axial scans were acquired 2 cm above and 5 and 10 cm below the horizontal midline in 105 patients. Measurements were bilateral in 13 patients. Finally, the results were compared with the surgical outcome. Femoral canal cross-diameters and cortical bone width varied greatly, which variations were confirmed in bilateral measurements and in the same patient between the two femurs. Femoral canal structure, which can be remodelled, influences the choice of the stem and thus the amount of cement. We believe this method to be fundamental for correct surgical planning and for best treatment outcome.
在过去几年中，髋关节置换术的应用越来越广泛，术前会对股骨近端的干骺端和骨干进行研究，以实现假体与骨骼之间的最佳匹配。实际上，通过降低柄端松动的风险可获得最佳效果，这意味着要选择最适合股骨髓腔的假体，并将及时松动风险较高的骨水泥假体的使用限制于重度骨质疏松患者。我们采用了一种简单且可重复的CT技术来研究股骨髓腔的结构和尺寸。在将患者精确置于扫描架内后，我们参照小转子水平中线在预定层面获取了一些轴向扫描图像。在105例患者中，于水平中线以上2 cm以及以下5 cm和10 cm处获取轴向扫描图像。13例患者进行了双侧测量。最后，将结果与手术结果进行比较。股骨髓腔的横径和皮质骨宽度差异很大，这种差异在双侧测量以及同一患者的双侧股骨之间得到了证实。可重塑的股骨髓腔结构会影响柄的选择，进而影响骨水泥的用量。我们认为这种方法对于正确的手术规划和最佳治疗效果至关重要。
