SPECT/CT对全膝关节置换术后不明原因疼痛的诊断价值

doi:10.12117/jccmi.2019.06.015

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摘要目的：探讨SPECT/CT对全膝关节置换术后患者不明原因疼痛的诊断价值。方法：对2012年10月—2016年6月51例因全膝关节置换术后疼痛而解剖影像学（DR、CT）检查未能明确诊断的患者，行99mTc-MDP SPECT/CT图像融合检查，探讨其诊断价值。疼痛原因最终经手术或6月以上的临床随访证实，计算SPECT/CT显像对其诊断效能。结果：51例患者，SPECT/CT显像阳性35例（68.63%），32例为真阳性，其中无菌性松动17例（股骨端松动6例，胫骨平台端松动7例，两者均松动4例），感染性松动6例，髌股关节骨性关节炎9例；3例假阳性，SPECT/CT显像提示为无菌性松动，随访证实为感染。阴性16例（其中假阴性2例，余14例为非假体及骨质源性疼痛）。对全膝关节置换术后不明原因疼痛的患者，SPECT/CT对假体或骨源性疼痛原因诊断灵敏度是91.43%（32/35）、特异度是87.5%（14/16）、符合率为86.49%（32/37）。结论：全膝关节置换术后患者，解剖影像学未能明确疼痛原因时，SPECT/CT显像可为临床提供有价值的参考信息。

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	张斌青
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	刘玉珂
	郭会利

关键词 ：膝关节, 疼痛, 体层摄影术, 发射型计算机, 单光子, 体层摄影术, X线计算机

Abstract：Objective: To investigate the diagnostic value of SPECT/CT for pain reason after total knee arthroplasty. Methods: From October 2012 to June 2016, 51 patients who failed to find the pain reasons by anatomical imaging(DR, CT) after total knee arthroplasty were examined by 99mTc-MDP SPECT/CT fusion imaging. The final diagnoses were made according to surgery, imaging results, or treatment outcome. All patients were followed up at least 6 months. Diagnostic efficiency of SPECT/CT was calculated. Results: Thirty-five(68.63%) in 51 cases had positive findings by SPECT/CT imaging. Thirty-two cases were true positive, including 17 cases of aseptic loosening(femoral loosening in 6 cases, tibial plateau loosening in 7 cases, both loosening in 4 cases), 6 cases of infectious loosening, patellofemoral joint disorders in 9 cases. Three cases of false positive, SPECT/CT imaging showed aseptic loosening, follow-up confirmed as infection. Sixteen cases showed negative (including false negative in 2 cases, the remaining 14 cases of non-prosthesis and bone-derived pain). For patients with unexplained pain after total knee arthroplasty, the sensitivity of SPECT/CT for the diagnosis of prosthetic or bone-derived pain was 91.43%(32/35), specificity was 87.5%(14/16), and the coincidence rate was 86.49%(32/37). Conclusion: When DR and CT imaging failed to diagnose the pain reason after total knee arthroplasty, SPECT/CT imaging can provide valuable reference information for clinical.

Key words： Knee joint Pain Tomography, emission-computed, single-photon Tomography, X-ray computed

收稿日期: 2018-07-20

PACS:	Ｒ684
	Ｒ817.4
	Ｒ814.42

通讯作者: 郭会利，河南省洛阳正骨医院（河南省骨科医院）影像中心，471002。E-mail：158111191@qq.com

作者简介: 张斌青（1981-），男，山西原平人，副主任医师。E-mail：sqfzbq@163.com

引用本文:

张斌青，宋青凤，刘玉珂，郭会利. SPECT/CT对全膝关节置换术后不明原因疼痛的诊断价值[J]. 中国临床医学影像杂志, 2019, 30(6): 437-440.
ZHANG Bin-qing, SONG Qing-feng, LIU Yu-ke, GUO Hui-li. Diagnostic value of SPECT/CT for pain reason after total knee arthroplasty. JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(6): 437-440.

链接本文:

http://www.jccmi.com.cn/CN/10.12117/jccmi.2019.06.015 或 http://www.jccmi.com.cn/CN/Y2019/V30/I6/437

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