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Sonographische Darstellung und Lokalisation von Metallimplantaten

Eine klinische Studie

Identification and localisation of metal implants using ultrasound examination

A clinical study

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Zusammenfassung

Nachdem in einer ersten experimentellen Studie die sonographische Darstellung und Lokalisation von Schrauben, Platten und Spickdrähten an Kunstknochen, Leichenknochen und Leichenextremitäten möglich war, wurde nun die Wertigkeit der Sonographie in der Identifikation von Implantaten bei typischen unfallchirurgischen Osteosyntheseverfahren erarbeitet. Bei 25 Patienten mit Oberschenkel-Verriegelungsmarknagelung, 28 Patienten mit Unterschenkel-Verriegelungsmarknagelung, 30 Patienten mit Schraubenosteosynthese und Verplattung konnten die Schrauben durch das sogenannte Resonanzartefakt (Kometenschweif-Artefakt), bedingt durch den hohen Impedanzunterschied zwischen umgebenden Weichteilen und metallischen Implantaten, sicher lokalisiert werden. Weiter konnten die Zahl der Schrauben, die Lokalisation zu umgebenden Strukturen, Schraubenlockerungen und eventuell reaktive Entzündungszeichen (Bursa) sonographisch gut dargestellt werden.

Abstract

In a first experimental study we investigated the visualisation of metal implants in reference to dimension, shape, material (titanium, steel, biodegradable screws) and surface structures and an eventual change of the echo pattern in correlation to the surrounding structures, the vicinity to bone and the change of the sound angle. For this purpose ultrasound investigation was performed in artificial and cadaver bones and in cadaver limbs after implantation of screws, plates, K-wires and cerclage wires. We found that metal implants of a certain dimension can be localised by typical artefacts (resonance artefact, comet tile artefact). In the following clinical study we investigated the value of ultrasound in finding and localisation of implants after osteosynthesis. In patients with 25 locking femur nailing, 30 locking tibia nailing, 30 osteosynthesis done by screws and plating, metal was easily localised by typical artefacts. Ultrasound examination gave the possibility to define the number of screws, the localisation to surrounding tissue, loosening of screws and eventual as sociated inflammatory tissue swelling (bursitis, tendovaginitis).

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Authors and Affiliations

  1. Universitätsklinik für Unfallchirurgie, Auenbrugger Platz 29, A-8036, Graz

    W. Grechenig, H. G. Clement, M. Fellinger & P. Schleifer

  2. Anatomisches Institut der Karl-Franzens-Universität Graz, Germany

    P. N. Tesch

Authors
  1. W. Grechenig
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  2. H. G. Clement
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  3. M. Fellinger
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  4. P. Schleifer
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  5. P. N. Tesch
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Grechenig, W., Clement, H.G., Fellinger, M. et al. Sonographische Darstellung und Lokalisation von Metallimplantaten. Unfallchirurgie 22, 117–123 (1996). https://doi.org/10.1007/BF02627517

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  • DOI: https://doi.org/10.1007/BF02627517

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