三相同位素骨扫描对TKA术后无菌性和感染性假体松动的鉴别诊断价值

Clinical Significance of Triple-phase Bone Scintigraphy in the Diagnosis of Loosening and Infection after Total Knee Arthroplasty(TKA)

目的：探讨三相同位素骨扫描技术在鉴别全膝关节置换术（ TKA）后无菌性假体松动及感染性假体松动中的价值。方法2010年1月～2014年8月期间行行骨三相显像的TKA术后患者共87例，观察患者假体松动区域在血流灌注相、血池相和平衡相放射性核素浓度变化，并且与健侧相同区域对照，经随访具有手术病理或穿刺病理明确诊断的共81例。最后经手术病理证实为松动的关节共40个，经病理证实为感染的共41个关节。结果81个关节中经手术病理证实为松动的人工关节共40个，骨三相诊断为松动的关节符合率为85．0％；最后确诊为感染的关节共有41个，骨三相诊断为感染的关节的符合率达95．1％．结论三相同位素骨扫描对于判断假体松动有很高的灵敏度，并可以明确病变部位，对手术有指导意义，可提高诊断TKA术后假体松动有无合并感染的准确性，骨三相在鉴别TKA术后假体松动与感染有较高的临床价值。

[ ABSTRACT] Objective To explore the clinical significance of technetium-99m-labelled triphase isotope scintigraphy in the diag-nosis of loosening and infection after total knee arthroplasty （TKA）.Methods A total of 87 cases received triple-phase bone scintigraphy from January 2010 to August 2014.The technetium 99m-labelled bone scintigraphy images were obtained to observe the density variation of the infection region during the blood flow phase ,blood pool phase and late phase and compared with normal lateral limb .Eighty-one joints of 81 cases were diagnosed by the puncture or operation pathology .In the 81 joints,40 joints were diagnosed as joint loosening by operation pa-thology.Forty-one joints were diagnosed as joint infection .Results The diagnosis coincidence rate was 85.0% that was diagnosed as joint loosening by triple-phase bone scintigraphy in the 40 joints that were confirmed by operation pathology;and the diagnosis coincidence rate was 95.1%that was diagnosed as joint infection in the 41 joints with joint infection .Conclusion Tiple-phase bone scintigraphy is a high sensi-tivity method to diagnose joint loosening .There is a high coincidence rate when loosening combined with infection .So there is a high clinical significance of triple-phase bone scintigraphy in the diagnosis of joint loosening and infection after arthroplasty .