^(99m)Tc-MDP骨三相显像对关节置换术后无菌性和感染性假体松动的鉴别诊断  

^(99m)Tc-MDP triple phase bone scintigraphy in differentiating aseptic loosening and septic loosening after joint replacement

作　　者：李欣欣[1] 张燕燕[1] 张卫方[1] 徐艳[1] 马婧[1] 

机构地区：[1]北京大学第三医院核医学科,北京100191

出　　处：《中国医学影像技术》2010年第12期2357-2359,共3页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨99mTc-MDP骨血流、血池、静态三相显像在鉴别骨关节置换术后无菌性假体松动及感染性假体松动中的价值。方法对12例关节置换术后怀疑假体松动的患者行99mTc-MDP骨三相显像,采用视觉法分析,与术中所见、术后病理、细菌培养、血沉、C反应蛋白等对照。结果与手术结果比较,99mTc-MDP静态显像诊断假体松动的准确率为87.50%。以单纯骨静态显像假体周围弥漫性浓聚为诊断感染的标准,灵敏度、特异度及准确率分别为33.33%、77.78%、66.67%;以血流或血池显像任意阳性结合骨静态显像阳性为诊断感染性松动的标准,灵敏度、特异度及准确率分别为100%、88.89%、91.67%。结论 99mTc-MDP骨静态显像对假体松动较为灵敏,并可提供假体松动的具体部位,对术前病情的评价有重要意义。以99mTc-MDP骨三相显像诊断松动有无合并感染,可提高诊断的准确性。Objective To explore the value of triple phase bone scintigraphy in differentiating aseptic loosening and septic loosening after joint replacement.Methods Twelve patients 2—8 years after joint replacement and suspected of peri-prosthetic infection were examined using triple phase bone scintigraphy,and the images were analyzed visually. The results of triple phase bone scintigraphy were validated with the findings of operation,biopsy,germiculture,erythrocyte sedimentation and C reactive protein. Results According to the findings of operation,the coincidence of 99mTc-MDP static state image was 87.50%. If diffused radioactivity was taken as the criterion of septic loosening,the sensitive,specificity and accuracy of 99mTc-MDP was 33.33%,77.78% and 66.67%,respectively. When taking increased of the isotope either in the blood flow phase or in the blood pool phase as the criterions of septic loosening,the sensitive,specificity and accuracy of 99mTc-MDP was 100%,88.89% and 91.67%,respectively. Conclusion 99mTc-MDP static state bone image is sensitive in diagnosing of aseptic loosening and describing the position of loosening. Triple phase bone scintigraphy may increase the accuracy of differentiating aseptic loosening and septic loosening.

关 键 词：放射性核素显像 关节成形术 置换 假体失败 假体相关性感染 

分 类 号：R817.4[医药卫生—影像医学与核医学]