Imaging evaluation after minimally invasive total hip arthroplasty

doi:10.3969/j.issn.2095-4344.2337

Abstract

Abstract:

BACKGROUND: Complications are unavoidable after minimally invasive total hip arthroplasty. At present, the imaging methods commonly used in clinical postoperative evaluation are diverse, and each has advantages and disadvantages.

OBJECTIVE: To introduce the application value and research progress of X-ray, CT, MRI and other imaging examination in the evaluation of curative effect after minimally invasive total hip arthroplasty.

METHODS: The first author retrieved the literature published in the PubMed, CNKI, and Wanfang database from 2000 to 2020. The key words were “surgical injury, MRI, minimally invasive, muscle trauma” in English, and “minimally invasive total hip arthroplasty, imaging, evaluation, muscle injury” in Chinese. The characteristics of different approaches of minimally invasive total hip arthroplasty and the imaging examination results of their effects on hip muscles were summarized and analyzed.

RESULTS AND CONCLUSION: (1) X-ray is the first choice for reexamination of patients after total hip arthroplasty. (2) Single photon emission CT of bone is not easy to be affected by metal artifacts, and shows higher sensitivity and specificity in patients with joint replacement. (3) MRI is the gold standard for the evaluation of peripheral muscle groups, especially muscle morphological changes. (4) The level of serum inflammatory cytokines, as a marker of muscle injury, is a specific and objective method for evaluating minimally invasive total hip arthroplasty. (5) Minimally invasive total hip arthroplasty can greatly avoid the incision or separation of muscles and tendons and reduce the risk of hip dislocation and fat liquefaction and necrosis after operation. Because of the weakening of muscle repair and regeneration ability in elderly patients, minimal invasion in total hip arthroplasty has a unique clinical position. Imaging examination plays an important role in the evaluation of minimally invasive surgery.

Key words: joint, prosthesis, minimally invasive, total hip arthroplasty, imaging, MRI, muscle, factor, review

CLC Number:

Zhang Yuda, Wang Changyao, Wang Xiangyu. Imaging evaluation after minimally invasive total hip arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(33): 5379-5384.

Figures/Tables 3

2.1.3 MRI 在暴露股骨颈及髋臼时，不可避免的要分离或切开髋周肌群，造成肌肉损伤。MRI是评估微创全髋关节置换术中肌肉损伤的重要影像学检查手段[10]。MRI结合了优越的组织对比度和检测骨髓水肿的能力，为软组织和骨性病理提供了准确和灵敏的评估，它可以确定全髋关节术后患者疼痛的肌肉原因，直观、准确地显示手术相关创伤的效果[11]。MüLLER等[12]针对接受直接外侧或微创全髋关节置换患者，在其术后3-12个月使用MRI评估了臀中肌的脂肪变性，结论显示使用微创方法可明显减少肌肉创伤，在老年人和超重患者中尤为明显。除软组织显像以外，MRI对人工假体周围骨组织显像也有独特价值，假体周围骨折MRI的诊断特点是急性期皮质、松质骨呈线性低信号改变，伴有周围骨髓水肿，而骨应力反应显示局限性水肿，其特征是髓腔、皮质、骨膜和邻近软组织高信号[13]。骨溶解患者的MR成像显示局灶性骨吸收区域，最常见的是等信号且边缘清晰的硬化灶。非特异性滑膜炎是指MRI显示单纯性关节液呈均匀的液体信号强度，滑膜厚度和信号强度正常或轻度增加的情况[14]，这一直接的影像学证据在评估手术入路和置入技术的优劣性方面有很大的好处。肌腱缺损和脂肪萎缩是与臀中肌、臀小肌、外展肌、外旋肌群等肌肉功能直接相关的结构变化，而MRI能够将活体形态学与个体功能结果关联起来[15]。因此MRI已经成为评价肌肉，特别是肌肉形态学改变的金标准[4]。此文筛选并总结3篇文献共197例患者，从全髋关节置换术后发生骨溶解、无菌性松动、假体周围感染3方面分析与评价X射线片、CT、MRI三者的诊断阳性率。经分析数据发现，X射线片诊断骨溶解、无菌性松动、感染的阳性率分别为78.4%，83.7%，35.0%；CT诊断阳性率为88.2%，88.3%，40.0%；MRI诊断阳性率为84.3%，95.3%，98.3%。因此在诊断感染方面，MRI阳性率明显大于X射线和CT，见图2，3。但在诊断无菌性松动和骨溶解方面，3种检查无明显差异[16]。这一现象与临床相符，也普遍被临床医师所接受。"

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