[雙語翻譯]醫(yī)學(xué)外文翻譯--金對金關(guān)節(jié)面周圍軟組織異常的超聲篩查（英文）

1、Ultrasound Screening of Periarticular Soft Tissue Abnormality Around Metal-on-Metal BearingsTakashi Nishii, MD, PhD,* Takashi Sakai, MD, PhD,y Masaki Takao, MD, PhD,y Hideki Yoshikawa, MD, PhD,y and Nobuhiko Sugano, MD,

2、PhD*Abstract: Although metal hypersensitivity or pseudotumors are concerns for metal-on-metal (MoM) bearings, detailed pathologies of patterns, severity, and incidence of periprosthetic soft tissue lesions are incomplete

3、ly understood. We examined the potential of ultrasound for screening of periarticular soft tissue lesions around MoM bearings. Ultrasound examinations were conducted in 88 hips (79 patients) with MoM hip resurfacings or

4、MoM total hip arthroplasties with a large femoral head. Four qualitative ultrasound patterns were shown, including normal pattern in 69 hips, joint-expansion pattern in 11 hips, cystic pattern in 5 hips, and mass pattern

5、 in 3 hips. Hips with the latter 3 abnormal patterns showed significantly higher frequency of clinical symptoms, without significant differences of sex, duration of implantation, head sizes, and cup abduction/anteversion

6、 angles, compared with hips with normal pattern. Ultrasound examination provides sensitive screening of soft tissue reactions around MoM bearings and may be useful in monitoring progression and defining treatment for per

7、iarticular soft tissue abnormalities. Keywords: metal-on-metal, ultrasound, MR imaging, soft-tissue reaction, bearings. © 2012 Elsevier Inc. All rights reserved.In the 2000s, renewed metal-on-metal (MoM) hip resurfa

8、cing and total hip arthroplasty (THA) with a large femoral head gained great popularity with the expectation of low bearing wear, high function and activity of patients, and low incidence of postoperative dislocation [1-

9、3]. As MoM hip arthroplasties have become more widespread, increasing abnormal reac- tions in periarticular soft tissue reactions that present as cysts, fluid collection, enhanced bursae, solid mass, and inflammatory mas

10、ses have been reported [4-10]. Some of these cases were related to severe pain in the hip or groin, palpable huge masses, or extensive periprosthetic bone loss leading to revision surgery with resection of soft tissue le

11、sions, and alteration in bearings with other materials [9]. From analyses of retrieved tissue and components, a delayed-type hypersensitive reaction specifically termed aseptic lymphocytic vasculitis–associatedlesions or

12、 response to excessive wear particles of MoM bearings was suspected as the main cause of the soft tissue reactions [5,11-13]. However, the detailed pa- thologies of patterns, severity, incidence, and natural course of pe

13、riprosthetic soft tissue lesions have not yet been elucidated. One of the difficulties encountered in investigation of periarticular soft tissue reactions around artificial joints is the absence of sensitive imaging moda

14、lities. Plain radiography and computed tomography are less sensi- tive for the evaluation of soft tissue disorders because of poor imaging contrast between normal and abnormal structures. Magnetic resonance imaging (MRI)

15、 has the advantages of superior imaging contrast for soft tissue abnormalities and the ready availability of 3-dimension- al assessment of abnormal lesions. However, the assessment of soft tissue reactions adjacent to th

16、e implant was difficult because of metal susceptibility artifacts even while using sophisticated metal artifact reduction techniques [9,14,15]. Ultrasound assessment around the hip arthroplasty has several advantages ove

17、r other imaging modalities. These include the absence of ionizing radiation, absence of metal artifacts introduced by implants, and relatively low cost [16]. Therefore, ultrasound assessment may be suit- able for the scr

18、eening of periarticular soft tissue reactions after hip arthroplasty. Some reports demonstrated the use of ultrasound for the evaluation of periarticular soft tissue reactions in MoM bearings [6,17,18].From the *Departme

19、nt of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan; and yDepartment of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka

20、, Suita, Osaka, Japan. Submitted April 4, 2011; accepted September 16, 2011. The Conflict of Interest statement associated with this article can be found at doi:10.1016/j.arth.2011.09.015. Reprint requests: Takashi Nishi

21、i, MD, Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. © 2012 Elsevier Inc. All rights reserved. 0883-5403/2706-0012$36.00/0

22、doi:10.1016/j.arth.2011.09.015895The Journal of Arthroplasty Vol. 27 No. 6 2012component; and (4) “mass pattern” with a large mass extending anterior to the femoral component. There were 69 hips with the normal pattern,

23、11 hips with the joint-expansion pattern, 5 hips with the cystic pattern, and 3 hips with the mass pattern. When the joint-expansion, cystic, and mass patterns were classified into the abnormal pattern on ultrasound, the

24、 frequency of clinical symptoms was significantly higher in hips with the abnormal pattern (63%) than in hips with thenormal pattern (25%) (Table 1). There was no signifi- cantly difference regarding other patients'

25、profiles, duration of implant in situ, types of operation and bearings, cup and head sizes, radiologic parameters of the implant placement, and presence of osteolysis, between the hip with normal and abnormal patterns. A

26、ll of the 3 patients showing mass pattern on ultrasound were women with M-THA operations and had only slight pain or discomfort in the hip (Table 2).Fig. 1. Classification of periarticular soft tissue reactions on anteri

27、or longitudinal or transverse ultrasound images: normal pattern (A), joint-expansion pattern (B), cystic pattern (C), and mass pattern (D). (Arrows indicate anterior capsule and arrowheads indicate mass lesion.)Ultrasoun