Na^(99)Tc^mO_4示踪显像监测家兔断肢再植术后血管危象的对比研究

Comparative study on observing vascular crisis of rabbits with replanted limb by Na^(99)Tc^mO_4 trace imaging

将40只家兔施行断肢再植术后20min随机分为A(25只)、B(15只)两组,A组伤口局部冷敷(<5°C)、B组热敷(40—45°C)10min,C组(5只正常对照家兔)置于室温(20—25°C)。所有家兔耳缘静脉注射Na99TcmO474MBq后行动态和静态显像,计算并分析再植部分和正常肢对应部分的放射性摄取比值(T/NT)。手术探查再植肢是否并发血管危象(VC)。根据术肢远端放射性聚集程度将显像结果分为Ο、Ⅰ、Ⅱ三级,结果显示:T/NT分别为0.142±0.061、0.472±0.055、0.843±0.184(t=7.23、13.65、2.71,P<0.01),将Ο级(T/NT<0.25)作为VC的定性和半定量诊断标准。手术探查证实A、B、C三组分别有25只、3只、0只家兔并发VC,局部冷敷制备VC动物模型的成功率100%;Na99TcmO4示踪显像(Na99TcmO4traceimaging,TTI)诊断VC的灵敏度(96.4%),明显高于临床常规方法(Clinicalroutinemethod,CRM)(39.3%)(χ2=20.9,P<0.01)。表明TTI较CRM更能直观而准确地反映再植末端的血供状况,能早期无创地监测断肢(指)再植术后VC的发生。

A method of observing the blood supply of rabbits with replanted limb by Na^99Tc^mO4 trace imaging （ TTI ） is described and compared with clinical routine method （CRM）. 40 healthy adult rabbits with replanted limb were divided into and A （ n = 25） and B （ n = 15 ） groups by 20 min after operation. Locally freezing （ 〈 5℃ ） 10 rain was given to group A and locally warming （40-45℃） was given to group B. Group C （5 normal control rabbits） was kept at common temperature （ 20-25℃ ）. Dynamic and static images were performed on all rabbits. The radioactivity uptake of replanted limb/normal limb ratio （T/NT） was analyzed using the region of interest analysis. The vascular crisis （VC） in 45 rabbits was evaluated with explorative operation. The O, Ⅰ and Ⅱ scales were classified according to their radionuclide distribution and the T/NT were 0.142 ± 0.061, 0.472 ± 0.055, 0.843 ± 0.184 （ t= 7.23, 13.65, 2.71, P 〈 0.01 ）, respectively. The O scales （T/NT 〈 0.25 ） of TTI can be regarded as a semi-quantitative and qualitative standard on diagnosing VC. 25, 3, 0 cases in groups A, B and C was confirmed with VC by explorative operation. The success rate of making VC model by locally freezing was 100%. The sensitivity （96.4%） in diagnosing VC by TTI was much higher than CRM （39.3 % ）（x^2= 20.9, P 〈 0.01 ）. It is conclude that the blood supply of rabbits with replanted limb could be reported more accurately and directly by TTI than CRM. TTI could play an important role on early and no traumatic diagnosing VC in patients with replanted finger or limb.