Smith S L, Wastie M L, Forster I
Department of Radiology, Queens Medical Centre, Nottingham, UK.
Clin Radiol. 2001 Mar;56(3):221-4. doi: 10.1053/crad.2000.0620.
Post-arthroplasty knee pain is common and clinically it can be difficult to identify those patients with complications requiring active treatment. The aim of this study was to determine the usefulness of(99)Tc(m)-MDP bone scintigraphy.
A retrospective study of all patients having a(99)Tc(m)-MDP bone scintigram for a painful knee arthroplasty between 1993 and 1999 was performed. Bone scintigrams were classified as normal or abnormal by a single observer. The results of these investigations were correlated with clinical outcome.
Seventy-five patients with painful knee arthroplasties were referred for investigation. A total of 80 bone scintigrams were performed. The average patient age was 66.2 years (42 female and 33 male). The mean time period between surgery and onset of knee pain was 3 years. A final clinical diagnosis based on arthroscopy, open surgery, and extended clinical follow-up was available for all patients. Forty-three (53.8%) of the scintigrams were normal and 37 (46.3%) abnormal. Two patients with a normal bone scintigram has loose prostheses. Thirteen patients with an abnormal study had normal prostheses on follow-up and these tended to be patients scanned less than a year after surgery. The sensitivity, specificity, positive predictive value and negative predictive value of an unequivocally normal or abnormal bone scintigram was 92.3, 75.9, 64.9 and 95.0%, respectively. The pattern of isotope uptake in the abnormal studies was not specific enough to reliably differentiate aseptic from septic loosening.
Radionuclide bone scintigraphy is useful in the assessment of the painful knee arthroplasty. A negative bone scintigram is reassuring and makes loosening or infection unlikely.
膝关节置换术后疼痛很常见，临床上难以识别那些需要积极治疗并发症的患者。本研究的目的是确定锝（99）Tc（m）-亚甲基二膦酸盐（MDP）骨闪烁显像的效用。
对1993年至1999年间因膝关节置换术后疼痛而进行锝（99）Tc（m）-MDP骨闪烁显像的所有患者进行回顾性研究。骨闪烁显像由一名观察者分类为正常或异常。这些检查结果与临床结果相关。
75例膝关节置换术后疼痛的患者被转诊进行检查。共进行了80次骨闪烁显像。患者平均年龄为66.2岁（女性42例，男性33例）。手术与膝关节疼痛发作之间的平均时间为3年。所有患者均有基于关节镜检查、开放手术和延长临床随访的最终临床诊断。43例（53.8%）骨闪烁显像正常，37例（46.3%）异常。两名骨闪烁显像正常的患者有假体松动。13例检查异常的患者随访时假体正常，这些患者往往是术后不到一年进行扫描的患者。明确正常或异常的骨闪烁显像的敏感性、特异性、阳性预测值和阴性预测值分别为92.3%、75.9%、64.9%和95.0%。异常检查中同位素摄取模式不够特异，无法可靠地区分无菌性松动与感染性松动。
放射性核素骨闪烁显像在评估膝关节置换术后疼痛方面有用。骨闪烁显像阴性令人放心，使松动或感染的可能性不大。
