放射性核素骨显像在人工关节置换后假体松动与感染鉴别诊断中的作用

背景：假体松动和感染是人工关节置换失败的常见原因,因此两者的鉴别非常重要。因大多患者无典型的临床表现,其他实验室检查的确诊方法也非常有限。目前,放射性核素骨显像与CT、磁共振成像及X射线检查已成为诊断假体松动和感染的常用方法,但何种方法能更有效地检查出病变,一直存在争论。目的：分析人工关节置换后假体松动和感染的放射性核素骨显像与CT、磁共振成像及X射线诊断的相关文献,对这些检查方法进行优选,为临床治疗方案的选择和预后的判断提供根据。方法：收集人工关节置换后假体松动和感染患者的放射性核素骨显像与CT、磁共振成像及X射线诊断的相关文献,对其影像学表现进行回顾性分析,比较几种影像学诊断方法的优缺点。结果与结论：人工关节置换后假体松动和感染的临床表现不容易区分,而且假体松动的早期尚未形成假体周围骨骼结构异常或假体周围较细小的透亮带被遮挡等,常影响X射线或者CT诊断,所以诊断时常出现误诊、漏诊。另外关节假体多为金属材料,CT或磁共振成像会出现伪影,也影响对假体松动和感染的判断。放射性核素骨显像可更准确的对人工关节置换后假体松动和感染的患者定位、定性诊断,对预后有更重要的临床价值。

Effects of radionuclide bone imaging in differential diagnosis of prosthesis loosening and infections after artificial joint replacement

BACKGROUND： Prosthetic loosening and infection is a frequent cause of failure of artificial joint replacement, therefore, it is important to distinguish between prosthetic loosening and infection. Because, most of the patients have no typical clinical presentation and the tresting and confirming methods of other laboratories are very limit, radionuclide bone imaging, CT and magnetic resonance imaging and X-ray inspection have become the commonly used method for the diagnosis of prosthetic loosening and infection. But which method can be more effective to check out the lesions, there has been a controversy. OBJECTIVE： To analyze the literatures on the radionuclide bone imaging, CT and magnetic resonance imaging and X-ray in the diagnosis of prosthetic loosening and infection after artificial joint replacement, to optimize these methods in order to provide basis for the selection of clinical treatment options and the diagnosis of prognosis. METHODS： The literatures on the radionuclide bone imaging, CT and magnetic resonance imaging and X-ray in the diagnosis of prosthetic loosening and infection after artificial joint replacement were selected, and its imaging performance was retrospective analyzed. The advantages and disadvantages of several methods of imaging diagnosis were compared. RESULTS AND CONCLUSION： The clinical manifestations of prosthesis loosening and infection after artificial joint replacement are not easy to distinguish, and not yet form the abnormal periprosthetic bone structure in the early loosening of the prosthesis and the periprosthetic smaller translucent band is obscured which affect the X-ray or CT diagnosis, so the diagnosis is often misdiagnosed. In addition, the joint prostheses are mostly metallic materials, and CT or magnetic resonance imaging may form artifacts which also affect the judgment of prosthetic loosening and infection. Radionuclide bone imaging can accurately position and qualitative diagnose the patients with prosthesis loosening and infection after artificial joint replacement, and has more clinical significance in prognosis.