CAJ | 학술논문

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19 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例三相同位索扫描结果阴性,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.
배경:유우전관관절치환후적가체무균성송동여감염존재상사적림상표현,량충병발증적감별진단흔곤난.목전몰유일충상규검사수단대우가체주위감염적진단구유이상적가고성,림상상결핍감염진단적"금표준".목적:탐토응용99득m표기적삼상동위소골소묘기술재전관관절치환후가체주위감염적진단개치.방법:선택11례전관관절치환후감염환자,균표현위지속성환관동통반가체송동화혈청학지표이상;기중남7례,녀4례,년령63.8(53～74)세,가체사용시19 14.5(0.5～30)년.이99득m표기적삼상동위소골소묘관찰환자감염구역재혈류관주상、혈지상화평형상방사성핵소농도변화,병차여건측상동구역대조,채용수궤자대연건환산성시간-방사성섭취량제도곡선,근거곡선차이정도득출진단결과.동시결합술중조직빙동절편병리결과(10개고배시야하중성백세포계수<5개,제시미감염)분석삼상동위소소묘진단적가고성.결과여결론:11례환자중2례삼상동위색소묘결과음성,동시술중빙동병리결과중성백세포계수<5개,일기가체번수;8례환자삼상동위소소묘결과양성,빙동병리절편백세포계수>5개,골수니간격식입,량기번수;1례삼상동위소소묘결과음성단병리결과양성,량기번수.결과현시삼상동위소골소묘양성검출솔동가체주위감염적학진유일정적상관성,결합조직병이학검사대우번수수술방식적선택유일정적림상개치.
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 tdple-phase bone scinitigraphy,and intraoperative frozen section analysis showed > 5polymorphonuclear 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.