核素心肌灌注显像在髋膝关节置换围术期评估老年患者心脏风险的价值  

Value of radionuclide myocardial perfusion imaging in cardiac risk assessment in elderly patients undergoing hip and knee arthroplasty

作　　者：陈鸿 黎咏诗 孙邦杰 曾羿[1] 杨静[1] Chen Hong;Li Yongshi;Sun Bangjie;Zeng Yi;Yang Jing(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《创伤外科杂志》2022年第5期346-351,共6页Journal of Traumatic Surgery

摘　　要：目的 探讨髋、膝关节置换围术期运用核素心肌灌注显像(MPI)评估老年患者心脏风险的价值,为进一步提高手术安全性提供术前筛查建议。方法 回顾性分析2018年9月1日—2020年9月1日四川大学华西医院骨科收治计划行关节置换的66例患者资料,男性19例,女性47例;年龄66~82岁,平均72.4岁;髋部骨折9例(骨折原因跌伤6例,撞伤2例,高处坠落伤1例),膝关节骨性关节炎41例,发育性髋关节发育不良继发骨关节炎6例,股骨头坏死10例。术前采用MPI检查筛查心肌缺血情况,存在灌注缺损则以冠状动脉造影(CAG)为金标准明确诊断。分别以MPI提示心肌灌注缺损总积分及CAG所示冠状动脉狭窄严重程度对患者进行危险度分层,统计MPI和CAG危险度分层情况、改变手术计划及围术期发生心肌缺血的人数。结果 MPI危险度分层情况低危组(轻度灌注缺损)48例,高危组(中、重度灌注缺损)18例;CAG危险度分层情况无支架置入指征者(低危)48例,有支架置入指征者(高危)18例。MPI发现严重心肌缺血患者的准确率为73%,阴性预测值为81%,阳性预测值为50%。MPI高、低危组各有9例患者因心肌缺血高风险取消手术,两组比例差异有统计学意义(9/18 vs.9/48,χ2=4.966,P=0.026);按计划手术患者术后无心肌缺血相关事件发生。结论 老年患者髋、膝关节置换术前运用MPI进行心脏风险评估,既可有效降低患者心脏风险未控制前直接手术的概率,提高手术安全性,也能避免不必要的有创性检查。Objective To explore the value of radionuclide myocardial perfusion imaging(MPI)in perioperative assessment of cardiac risk in elderly patients undergoing hip and knee arthroplasty,and to provide preoperative screening suggestions for further improving the safety of operation.Methods Retrospective analysis was conducted in the clinical data of 66 patients who planned to undergo THA/TKA admitted to Department of Orthopedics,West China Hospital from Sep.2018 to Sep.2020.There were 19 males and 47 females,with an average age of 72.4 years(range,66-82 years).There were 9 cases of hip fracture(6 cases of fall injury,2 cases of bump injury and 1 case of falling from high place),41 cases of knee osteoarthritis,6 cases of hip developmental dysplasia,and 10 cases of femoral head osteonecrosis.Preoperative MPI was used to screen myocardial ischemia,and coronary angiography was used as the gold standard to confirm the diagnosis for patients with perfusion defect.The patients were stratified according to the total score of myocardial perfusion defect indicated by MPI and the severity of coronary artery stenosis shown by CAG.The risk stratification of MPI and CAG,the change of operation plan and the number of myocardial ischemia were calculated.Results There were 48 cases of MPI low-risk group(mild perfusion defect)and 18 cases of high-risk group(moderate and severe perfusion defect);for CAG examination,there were 48 cases without stent implantation indication(low risk)and 18 cases with stent implantation indication(high risk).The accuracy,negative predictive value and positive predictive value of MPI in the diagnosis of severe coronary stenosis were 73%,81%,50%,respectively.Nine patients in MPI high risk group and 9 patients in MPI low risk group cancelled the operation because of high risk of myocardial ischemia,and there was significant difference between the two groups(9/18 vs.9/48,χ2=4.966,P=0.026).There was no myocardial ischemia related events in patients after operation according to the plan.Conclusion MPI examinatio

关 键 词：关节置换术 核素心肌显像 冠状动脉造影 心肌缺血 

分 类 号：R687.4[医药卫生—骨科学]