99Tc^m-MDP三相骨显像联合CT成像对创伤后骨髓炎的诊断价值

The Diagnostic Efficacy of 99 Tc m-MDP TPBS Combined with CT in theDetection of Infections in Post-Traumatic Fracture Delayed Union

目的探讨99 Tc m-MDP三相骨显像(TPBS)联合CT扫描诊断创伤后骨髓炎的临床应用价值。方法回顾性分析北京积水潭医院76例创伤后骨折愈合不良患者(男49例,女27例,年龄19~65岁)的临床及影像学资料,患者均行99 Tc m-MDP三相骨显像和骨折部位CT扫描,根据术后临床诊断及随访结果,分析三相骨显像中单一应用血流相、血池相和CT以及联合应用三相骨显像与CT扫描诊断创伤后骨髓炎的灵敏度、特异性和准确性,并通过统计学分析进行比较。结果对于创伤后骨髓炎的诊断,单一应用血流相的灵敏度为88.1%(37/42),特异性为73.5%(25/34),准确性为81.6%;单一应用血池相的灵敏度为85.7%(36/42),特异性为67.6%(23/34),准确性为77.6%;单一应用CT扫描的灵敏度为73.8%(31/42),特异性为64.7%(22/34),准确性为66.7%。三相骨显像联合CT扫描诊断骨折术后感染的灵敏度为90.5%(38/42),特异性为85.3%(29/34),准确性为88.2%。99 Tc m-MDP TPBS联合CT的诊断特异性及准确度高于单一应用血流相或血池相,99 Tc m-MDP TPBS联合CT的诊断灵敏度、特异性及准确度高于单一应用CT扫描,差异具有统计学意义。结论99 Tc m-MDP三相骨显像联合CT扫描能够通过提高诊断特异性从而提高诊断准确性,在创伤后骨髓炎的诊断中具有重要的增益价值。

Objective To investigate whether combined application of 99 Tc m-MDP three-phase bone scintigraphy(TPBS)and CT scanning had the incremental value in accurately detecting post-traumatic osteomyelitis.Methods 76 patients with post-traumatic fracture delayed union(49 men and 27 women;age range,19-65 y)underwent both 99 Tc m-MDP TPBS and CT scanning.The sensitivity,specificity and accuracy of blood flow phase,blood pool phase and CT scanning alone and 99 Tc m-MDP TPBS combined with CT scanning were determined respectively.Results With the method of blood flow phase alone in detecting infections in post-traumatic fracture delayed union,the sensitivity,specificity,and accuracy were 88.1%(37/42),73.5%(25/34),and 81.6%,respectively,while blood pool phase alone had values of 85.7%(36/42),67.6%(23/34),and 77.6%,respectively.With the method of CT scan alone,the sensitivity,specificity,and accuracy were 73.8%(31/42),64.7%(22/34),and 66.7%,respectively.With the method of combined application of 99 Tc m-MDP TPBS and CT scanning,the sensitivity,specificity and accuracy were 90.5%(38/42),85.3%(29/34)and 88.2%,respectively.The specificity and accuracy of the combined application of 99 Tc m-MDP TPBS and CT scanning were both higher than those of 99 Tc m-MDP TPBS alone.The sensitivity,specificity and accuracy of combined application of 99 Tc m-MDP TPBS and CT scanning were all higher than those of CT alone.The difference were all statistically significant.Conclusion The combined application of 99 Tc m-MDP TPBS and CT had an incremental value in accurately detecting infections in post-traumatic fracture delayed union,compared with only using blood flow phase or blood pool phase alone of 99 Tc m-MDP TPBS.