发射单光子计算机断层扫描在关节置换感染翻修中的应用价值

Clinical value of the ECT bone scan in diagnosis of prosthesis infection for revision

目的 ：评价发射单光子计算机断层扫描（emission computed tomography,ECT）全身骨扫描在髋膝关节置换术后感染二次关节翻修术前感染控制评估方面的应用价值。方法：回顾性分析62例初次关节置换后假体周围感染的患者,其中男34例,女28例;年龄65~74岁,平均68.8岁。手术前行ECT骨扫描、血沉、C-反应蛋白检查,根据结果做出判断,ECT与C-反应蛋白、血沉两者之一阳性,可判定为感染,任意两项阴性即认为感染已排除。同时将结果与＂金标准＂术中行组织冰冻切片检查进行对比。结果 ：ECT骨扫描灵敏性、特异性及准确性分别为75.0%,88.9%及87.1%;ESR分别为50.0%,72.2%及69.4%;CRP分别为62.5%,81.5%及79.0%;3种方法联合检测分别为87.5%,96.3%及95.2%。结论：ECT骨扫描在排除感染方面较血沉、C-反应蛋白更准确、灵敏,三者联合应用时可提高关节翻修术前感染的排除诊断,值得推广和应用。

Objective ：To detect the clinical value of the ECT bone scan in evaluating of the situation of infection control after hip knee arthroplasty. Methods ：The clinical data were retrospectively analyzed in 62 patients ,including 34 males and 28 females with an average age of 68.8 years old ranging from 65 to 74 years. The results of ECT bone scan, erythrocyte sedimen- tation rate, C-reactive protein were used to assess periprosthetic infection. The patients with positive ECT and ESR on CRP were considered to have periprosthetic infection;however,the patients with two or more negative indexes were considered to have no infection. Results：The sensitivitY,SPecificity,accurate rate of ECT were 75.0% ,88.9% ,87.1% respectively ;ESR 50.0% ,72.2%, 69.4% ;CRP 62.5% , 81.4%,79.0%. The combination of the three methods were 87.5% ,96.3% and 95.2%. Conclusion：Compared with ESR and CRP, ECT is a more effective way in the diagnosis of periprosthetic infection, which has great value and is worth popularizing.