髋关节置换术后中长期随访无症状患者^(99m)Tc三相同位素骨扫描结果分析

Analysis of ^(99m)Tc triple-phaseisotope bone scanning results forasymptomatic patients after a mid-long term follow-up of hip arthroplasty

目的研究髋关节置换术后正常的患者人群中^(99m)Tc三相同位素骨扫描结果,前瞻性的统计骨扫描对于人工髋关节置换术后无症状患者的诊断价值。方法 2015年4月至2015年12月随访全髋关节置换术后功能正常患者27例(男4;女23)。单侧置换19例(右10;左9),双侧置换8例,共35个髋关节假体。所有患者进行Harris评估,患者均接受血清学检查和三相同位素骨扫描。结果 27例中4例(6髋)血沉超过正常值。4例(4髋)C-反应蛋白超过正常值。27例中25例三相同位素骨扫描为阴性,2例同位素骨扫描为阳性。血沉结果同临床症状之间阴性一致率82.86%;C-反应蛋白结果同临床症状之间阴性一致率88.57%;骨扫描结果同临床症状之间阴性一致率94.29%;三项联合运用结果同临床症状之间阴性一致率71.43%。结论本组研究主要针对假体置换术后5年以上病例,假体稳定并且无症状。研究发现,27例(35髋)中25例(33髋)三相同位素骨扫描阴性。同位素骨扫描的阴性结果同临床症状的一致率94.29%,动态放射性核素显像能够反应骨与假体界面之间的血流变化,从而进一步判断假体周围感染。

Objective To investigate the ^99mTc triple-phaseisotope bone scanning results fomormal patients after hip ar-throplasty, prospectively analyze the diagnostic value of isotope bone scan to asymptomatic patients after hip arthroplasty. Methods From Apr 2015 to Dec 2015, 27 cases after total hip arthroplasty （4 males and 23 females） were followed up in outpatient department, in which 19 cases （10 right side and 9 left side） were unilateral and 8 cases were bilateral. Harris hip joint function evaluation was taken in all cases. Both serological examinations and triple-phaseisotope bone scanning were performed in all cases. Results The erythrocyte sedimentation rate exceeded the normal range in 4 cases （6 hips） out of all the 27 cases, and the C-reactive protein value was higher than normal in 4 cases （4 hips）. Of all the 27 cases, 25 cases had negative resiilts for the triple-phase bone scanning, while the rest 2 cases had positive results. The consistent negative rate between the results of erythrocyte sedimentation rate and clinical symptoms was 82.35%; consistent negative rate between the results of C-reactive protein and clinical symptoms was 88.24%; consistent negative rate between the results of bone scanning and clinical symptoms was 94.12%. When applying all these three diagnostic procedures federatively, consistent negative rate between the results of examinations and clinical symptoms was 71.43%. Conclusion This study mainly aimed at cases who had undergone prosthesis arthroplasty more than 5 years, with well prosthesis stability and no symptom. Results of this study have shown that, 25 （33 hips） out of 27 cases （35 hips） had negative results for the triple-phase bone scanning. The concordance rate between the negative results of the isotope bone scan and clinical symptoms was 94.29%. Dynamic radionuclide imaging was able to reflect the blood flow changes on the interface between bone and the prosthesis, and go a step further to detect periprosthetic joint infection.