中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (17): 3041-3045.doi: 10.3969/j.issn.1673-8225.2010.17.001

• 人工假体 artificial prosthesis •    下一篇

三相同位素骨扫描诊断髋关节置换后感染的临床意义

张  炅，冯建民，王  毅，杨庆铭，刘志宏，何  川   

  1. 上海交通大学附属瑞金医院骨科，上海市  200025
  • 出版日期:2010-04-23 发布日期:2010-04-23
  • 通讯作者: 冯建民，主任医师，上海交通大学附属瑞金医院骨科，上海市 200025 fengjm@shtel.net.cn
  • 作者简介:张 炅，男，1973年生，上海市人，汉族，1998年上海交通大学医学院毕业，主治医师，主要从事关节外科研究。 zj10921@msn.com

Clinical significance of triple-phase bone scintigraphy in diagnosing peri-prosthetic infection following hip arthroplasty 

Zhang Jiong, Feng Jian-min, Wang Yi, Yang Qing-ming, Liu Zhi-hong, He Chuan   

  1. Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai  200025, China
  • Online:2010-04-23 Published:2010-04-23
  • Contact: Feng Jian-min, Chief physician, Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai 200025, China fengjm@shtel.net.cn
  • About author:Zhang Jiong, Attending physician, Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai 200025, China zj10921@msn.com

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500

被引次数

6

摘要：

背景：由于全髋关节置换后的假体无菌性松动与感染存在相似的临床表现，两种并发症的鉴别诊断很困难。目前没有一种常规检查手段对于假体周围感染的诊断具有理想的可靠性，临床上缺乏感染诊断的“金标准”。
目的：探讨应用99锝m标记的三相同位素骨扫描技术在全髋关节置换后假体周围感染的诊断价值。
方法：选择11例全髋关节置换后感染患者，均表现为持续性患髋疼痛伴假体松动和血清学指标异常；其中男7例，女4例，年龄63.8(53~74)岁，假体使用时间14.5(0.5~30)年。以99锝m标记的三相同位素骨扫描观察患者感染区域在血流灌注相、血池相和平衡相放射性核素浓度变化，并且与健侧相同区域对照，采用随机自带软件换算成时间-放射性摄取量梯度曲线，根据曲线差异程度得出诊断结果。同时结合术中组织冰冻切片病理结果(10个高倍视野下中性白细胞计数< 5个，提示未感染)分析三相同位素扫描诊断的可靠性。
结果与结论：11例患者中2例三相同位素扫描结果阴性，同时术中冰冻病理结果中性白细胞计数< 5个，一期假体翻修；8例患者三相同位素扫描结果阳性，冰冻病理切片白细胞计数> 5个，骨水泥间隔植入，两期翻修；1例三相同位素扫描结果阴性但病理结果阳性，两期翻修。结果显示三相同位素骨扫描阳性检出率同假体周围感染的确诊有一定的相关性，结合组织病理学检查对于翻修手术方式的选择有一定的临床价值。

关键词: 同位素骨扫描, 关节成形术, 髋, 感染, 诊断, 全髋关节置换, 髋关节假体

Abstract:

BACKGROUND: Aseptic loosening and infection are difficult to diagnose due to their similar clinical manifestations following total hip replacement. There lacks routine examinations or gold standard to diagnose peri-prosthetic infection.
OBJECTIVE: To evaluate the clinical effectiveness of technetium-99m-labelled triphase isotope scinitigraphy in the diagnosis of peri-prosthetic infection following total hip arthroplasty.
METHODS: A total of 11 patients with suspected peri-prosthetic infection were selected, with continuous hip pain, prosthesis loosening and abnormal serum indexes, including 7 males and 4 females, with an average age of 63.8 (53-74) years. The average time of prosthesis usage was 14.5 (0.5-30) years. The technetium 99m-labelled bone scintigraphy images were obtained to observe the density variation of the infection region during the blood flow phase, blood pool phase and late phase and compared with normal lateral limb. Time-radioactive uptake curve was made using software to analyze the diagnostic results. In addition, the diagnostic value of the triple-phase bone scinitigraphy was analyzed using the intraoperative frozen section results (neutrophil < 5 under 10 high power visual fields: no infection).
RESULTS AND CONCLUSION: Of 11 patients, 2 cases showed negative result of triple-phase bone scinitigraphy, and intraoperative frozen section analysis showed < 5 polymorphonuclear cells per high-power field, who underwent one-stage revision surgery; 8 displayed positive result of triple-phase bone scinitigraphy, and intraoperative frozen section analysis showed > 5 polymorphonuclear cells per high-power field, who underwent two-stage revision surgery; 1 case showed negative result of triple-phase bone scinitigraphy but intraoperative frozen section analysis showed > 5 polymorphonuclear cells per high-power field, who also underwent two-stage revision surgery. Results show that positive results of triple-phase bone scintigraphy were related to peri-prosthetic infection, which has great value for revision surgery in combination with histopathological examination.

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