中华核医学与分子影像杂志
中華覈醫學與分子影像雜誌
중화핵의학여분자영상잡지
Chinese Journal of Nuclear Medicine and Molecular Imaging
2013年
4期
267-270
,共4页
髋关节%外科手术%髋假体%放射性核素显像%MDP
髖關節%外科手術%髖假體%放射性覈素顯像%MDP
관관절%외과수술%관가체%방사성핵소현상%MDP
Hip joint%Surgery,operative%Hip prosthesis%Radionuclide imaging%MDP
目的 探讨99Tcm-MDP显像用于髋关节置换术后关节感染与无菌性假体松动鉴别诊断的适合方法.方法 回顾性分析2008年2月至2011年8月间74例人工髋关节置换术后出现关节疼痛的患者资料,其中男32例,女42例,年龄(64.3±11.2)岁.所有患者均行99Tcm-MDP血流、血池和骨骼三时相显像及血清C反应蛋白和血红细胞沉降率测定.99Tcm-MDP显像分别以假体周围软组织放射性浓聚、假体周围骨骼放射性浓聚或两者同时存在作为关节感染的诊断依据；无上述阳性表现者即认为关节疼痛由无菌性假体松动所致.依据最终临床诊断,采用x2检验比较99Tcm-MDP显像中骨骼相、血流-血池相、血清学检查结果间诊断效能的差异.结果 74例患者中,有症状关节74个,其中感染关节24个,无菌性假体松动50个.诊断关节感染的灵敏度和特异性:血流-血池相分别为91.7％(22/24)和90.0％ (45/50),骨骼相分别为70.8％ (17/24)和48.0％ (24/50),血清C反应蛋白分别为62.5％ (15/24)和78.0％ (39/50),血红细胞沉降率分别为62.5％ (15/24)和76.0％ (38/50).血流-血池相对假体周围感染诊断的准确性优于单纯骨显像[90.5％ (67/74)和55.4％ (41/74);x2=23.159,P＜0.001],也优于血清C反应蛋白[73.0％(54/74) ;x2 =7.656,P＜0.05]和血红细胞沉降率[71.6％(53/74);x2 =8.633,P＜0.05]检测.结论 在髋关节置换术后关节感染与无菌性假体松动鉴别诊断中,99Tcm-MDP血流-血池相具有较高的临床价值,建议作为常规检查方法.
目的 探討99Tcm-MDP顯像用于髖關節置換術後關節感染與無菌性假體鬆動鑒彆診斷的適閤方法.方法 迴顧性分析2008年2月至2011年8月間74例人工髖關節置換術後齣現關節疼痛的患者資料,其中男32例,女42例,年齡(64.3±11.2)歲.所有患者均行99Tcm-MDP血流、血池和骨骼三時相顯像及血清C反應蛋白和血紅細胞沉降率測定.99Tcm-MDP顯像分彆以假體週圍軟組織放射性濃聚、假體週圍骨骼放射性濃聚或兩者同時存在作為關節感染的診斷依據；無上述暘性錶現者即認為關節疼痛由無菌性假體鬆動所緻.依據最終臨床診斷,採用x2檢驗比較99Tcm-MDP顯像中骨骼相、血流-血池相、血清學檢查結果間診斷效能的差異.結果 74例患者中,有癥狀關節74箇,其中感染關節24箇,無菌性假體鬆動50箇.診斷關節感染的靈敏度和特異性:血流-血池相分彆為91.7％(22/24)和90.0％ (45/50),骨骼相分彆為70.8％ (17/24)和48.0％ (24/50),血清C反應蛋白分彆為62.5％ (15/24)和78.0％ (39/50),血紅細胞沉降率分彆為62.5％ (15/24)和76.0％ (38/50).血流-血池相對假體週圍感染診斷的準確性優于單純骨顯像[90.5％ (67/74)和55.4％ (41/74);x2=23.159,P＜0.001],也優于血清C反應蛋白[73.0％(54/74) ;x2 =7.656,P＜0.05]和血紅細胞沉降率[71.6％(53/74);x2 =8.633,P＜0.05]檢測.結論 在髖關節置換術後關節感染與無菌性假體鬆動鑒彆診斷中,99Tcm-MDP血流-血池相具有較高的臨床價值,建議作為常規檢查方法.
목적 탐토99Tcm-MDP현상용우관관절치환술후관절감염여무균성가체송동감별진단적괄합방법.방법 회고성분석2008년2월지2011년8월간74례인공관관절치환술후출현관절동통적환자자료,기중남32례,녀42례,년령(64.3±11.2)세.소유환자균행99Tcm-MDP혈류、혈지화골격삼시상현상급혈청C반응단백화혈홍세포침강솔측정.99Tcm-MDP현상분별이가체주위연조직방사성농취、가체주위골격방사성농취혹량자동시존재작위관절감염적진단의거；무상술양성표현자즉인위관절동통유무균성가체송동소치.의거최종림상진단,채용x2검험비교99Tcm-MDP현상중골격상、혈류-혈지상、혈청학검사결과간진단효능적차이.결과 74례환자중,유증상관절74개,기중감염관절24개,무균성가체송동50개.진단관절감염적령민도화특이성:혈류-혈지상분별위91.7％(22/24)화90.0％ (45/50),골격상분별위70.8％ (17/24)화48.0％ (24/50),혈청C반응단백분별위62.5％ (15/24)화78.0％ (39/50),혈홍세포침강솔분별위62.5％ (15/24)화76.0％ (38/50).혈류-혈지상대가체주위감염진단적준학성우우단순골현상[90.5％ (67/74)화55.4％ (41/74);x2=23.159,P＜0.001],야우우혈청C반응단백[73.0％(54/74) ;x2 =7.656,P＜0.05]화혈홍세포침강솔[71.6％(53/74);x2 =8.633,P＜0.05]검측.결론 재관관절치환술후관절감염여무균성가체송동감별진단중,99Tcm-MDP혈류-혈지상구유교고적림상개치,건의작위상규검사방법.
Objective To investigate the value of 99Tcm-MDP imaging for the differential diagnosis between infection and aseptic loosening after total hip arthroplasty.Methods During February 2008 to August 2011,74 patients (32 males,42 females,average age (64.3±11.2) years) with hip pain after arthroplasty underwent 3-phase (blood flow,blood pool and bone phases) 99Tcm-MDP imaging.All patients had measurements of serum C reactive protein (CRP) and erythrocyte sedimentation rate (ESR).Joint infection was defined as either increased peri-prosthetic soft tissue activity during perfusion and blood pool phases or increased peri-prosthetic bone activity during uptake phase,or positive in all 3 phases.Aseptic loosening was defined as having negative 99Tcm-MDP in all 3 phases.Clinical diagnosis was chosen as the gold standard.The blood flow-pool imaging was compared with the serum examinations.x2 test was used for statistical analysis.Results There were 74 symptomatic joints in 74 patients,including 24 joint infections and 50 aseptic loosening.For the detection of peri-prosthetic infection,combined perfusion-blood-pool phase was more accurate than bone uptake phase (90.5％ (67/74) vs 55.4％ (41/74) ;x2=23.159,P＜0.001),with the sensitivity of 91.7％ (22/24)vs 70.8％ (17/24) and specificity of 90.0％ (45/50) vs 48.0％ (24/50),respectively.The blood flow-pool imaging was also more accurate than CRP (73.0％ (54/74) ;x2 =7.656,P＜0.05) and ESR (71.6％ (53/74) ; x2 =8.633,P＜0.05),respectively.Conclusion 99Tcm-MDP perfusion/blood flow-pool imaging is an accurate modality for differentiating peri-prosthetic infection from aseptic loosening in patients with hip pain after arthroplasty.
