| BackgroundHip connected body and lower extremities, is the largest joints of the human body. Total hip arthroplasty (THA) is necrosis of the femoral head, femoral neck fracture, ankylosing spondylitis or other diseases caused by hip damage to be replaced, ease joint pain, improve joint function, joint deformity correction, to improve the quality of life of patients, to rebuild a near-normal joint.However, the osteolysis of hip arthroplasty major complications. Studies have shown that artificial joints produced by wear particle-induced osteoclast activity enhancement resulting in periprosthetic osteolysis, is considered the main reason for aseptic loosening.Imaging studies is one of the primary examination of artificial hip replacement. The main examination include Digital X-ray imaging (Digital radiography, DR), CT, MRI, and so onoIn this study,65patients (89hips), that hip had replaced more than one year are research subjects, they all had DR and DTS exam at the same time, in which24patients (39hips) done CT exam. Two high qualification of diagnostic imaging diagnostician diagnose independently. The first part is the optimal selection of DTS, include two position (hip anteroposterior and hip oblique) and three image reconstruction method (standard algorithm, reducing metal artifact algorithm, high contrast algorithm). The second part is the comparison between DR and DTS in finding osteolysis around hip prosthesis. The third part is the comparison between DTS and CT in finding osteolysis around hip prosthesis. This study will reserch the clinical value of three imaging examination, DR, DTS and CT, find the way of DTS in clinical work.PART I:the Optimal Selectiong of Position and Reconstruction Method in DTSMaterials and Method12patients (15hips) all have performed hip arthroplasties and had done DTS exam during2011to2012. DTS equipment is Japanese Shimadzu Sonialvsion Safire II Tomosynthesis. All paitents do twice DTS exam, one in hip anteroposterior, another in hip oblique, use3reconstruction method:standard algorithm, reducing metal artifact algorithm, high contrast algorithm. Imaging diagnositician look up osteolysis around hip prosthesis. Count the osteolysis doctor found for statistical analysis. Partitioning methods of artificial acetabular is Delee-Charnley’s methods, partitioning methods of femoral stem is Gruen-Amstutz’s methods.Results1. Position:in hip anteroposterior,26osteolysis was found around artificial acetabular and48osteolysis was found around femoral stem; in hip oblique,28osteolysis was found around artificial acetabular and31osteolysis was found around femoral stem. The difference around artificial acetabular was not statistically significant, the difference around femoral stem was statistically significant.2. Reconstruction method:in standard algorithm,20osteolysis was found around artificial acetabular and36osteolysis was found around femoral stem; in reducing metal artifact algorithm,26osteolysis was found around artificial acetabular and48osteolysis was found around femoral stem; in high contrast algorithm,19osteolysis was found around artificial acetabular and33osteolysis was found around femoral stem. The difference around artificial acetabular and the difference around femoral stem all was statistically significant.ConclusionIn hip anteroposterior DTS found more osteolysis than in hip oblique. So, we use hip anteroposterior in later study..The reducing metal artifact algorithm can found more osteolysis than standard algorithm and high contrast algorithm, so we choose reducing metal artifact algorithm in later study.PART II:the Comparative Study of DTS and DRMaterials and Methods65patients (89hips) all have performed hip arthroplasties and had done DR and DTS exam at the same time during2011to2012. DTS equipment is Japanese Shimadzu Sonialvsion Safire II Tomosynthesis and DR equipment is German Siemens Aristos MX DR. Analysis Method is same with the pre-test.ResultsDR found97osteolysis around artificial acetabularand134osteolysis around femoral stem. DTS found126osteolysis around artificial acetabularand209osteolysis around femoral stem. The difference between DTS and DR around artificial acetabular and femoral stem was statistically significant..ConclusionAround artificial acetabular, there was statistical significance between DTS and DR in the upper inner area, the edge of pubic and the edge of ischial was statistically significant; the other arer was not statistically significant. Around femoral stem, there was statistical significance between DTS and DR in the upper outer area, the outer of center, the lower outer area and the upper inner area was statistically significant; the other arer was not statistically significant. DTS is better than DR in finding osteolysis around artificial acetabular.The lower inner area found most osteolysis around artificial acetabularand, because of artificial joints wear particles excretion. The upper area found more osteolysis than the lower area, because of stress shielding effect.PART III:the Comparative Study of DTS and CTMaterials and Methods24patients (33hips) all have performed hip arthroplasties and had done DTS and CT exam at the same time during2011to2012. DTS equipment is Japanese Shimadzu Sonialvsion Safire Ⅱ Tomosynthesis and CT equipment is German Siemens Somatom Emotion16. Analysis Method is same with the pre-test.ResultsDTS found54osteolysis around artificial acetabularand98osteolysis around femoral stem. CT found73osteolysis around artificial acetabularand128osteolysis around femoral stem. The difference between DTS and CT around artificial acetabular and femoral stem was statistically significant.ConclusionThere was statistical significance between DTS and DR in the after edge of acetabularand and both edge of center. CT is better than DTS in finding osteolysis around artificial acetabular.If both side all performed hip arthroplasties, some tomography of CT will appear serious artifacts.In summary, it is recommended for the radiography examination of hip arthroplasties patient that1st,2nd,3rd mouth do DR,6th mouth do DTS,12th mouth do CT, then do DR and DTS cyclically each year.The conclusions1. The per-test of the hip DTS shows, hip anteroposterior was better than hip oblique; the reducing metal artifact algorithm was better than standard algorithms and high-contrast algorithm.2. DTS is better than DR in finding osteolysis around artificial acetabular. Around artificial acetabular, there was statistical significance between DTS and DR in the upper inner area, the edge of pubic and the edge of ischial was statistically significant; the other arer was not statistically significant. Around femoral stem, there was statistical significance between DTS and DR in the upper outer area, the outer of center, the lower outer area and the upper inner area was statistically significant; the other arer was not statistically significant.3. The lower inner area found most osteolysis around artificial acetabularand, because of artificial joints wear particles excretion. The upper area found more osteolysis than the lower area, because of stress shielding effect.4. CT is better than DTS in finding osteolysis around artificial acetabular. There was statistical significance between DTS and DR in the after edge of acetabularand and both edge of center. CT is better than DTS in finding osteolysis around artificial acetabular. If both side all performed hip arthroplasties, some tomography of CT will appear serious artifacts.5. In summary, it is recommended for the radiography examination of hip arthroplasties patient that in1st,2nd,3rd mouth do DR,6th mouth do DTS,12th mouth do CT, then do DR and DTS cyclically. |
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