Department of Orthopedic Surgery, Ain Shams University, Cairo, Egypt.
Skeletal Radiol. 2010 Oct;39(10):1009-16. doi: 10.1007/s00256-010-0887-3. Epub 2010 Feb 23.
As pasteurization is becoming more widely used in limb salvage reconstruction, more study is required to understand about host-graft junction healing, graft revascularization and incorporation, and the incidence and type of complications among pasteurized autografts. This was mainly achieved by follow-up radiography. We aimed to clarify whether Tc99m bone scanning can be considered a reliable method in determining these three parameters.
Twenty-seven osteosarcoma patients with pasteurized autograft reconstructions were retrospectively reviewed using available scintigraphic and radiographic follow-up every 6 months postoperatively for 36 months. Follow-up of the unhealed cases was continued for the maximum follow-up period available for each case beyond the original study period, ranging from 1 to 15 months. Tc99m uptake was classified as cold, faint, moderate and high uptake. Junction healing was classified as none, partial and complete healing.
Seventy percent of junctions united with a mean of 22 months. Ninety to 100% of junctions showed increased uptake (high or moderate) at one time of the study regardless of final outcome. 85% of the pasteurized grafts showed the characteristic "tramline appearance". Four grafts (15%) were complicated: pseudoarthrosis and implant failure (1), fractured plate (1), intramedullary nail (IMN) fracture (1), and prosthesis stem loosening in the host bone (1), with underlying unhealed junctions in all cases.
Bone scanning can determine the stages of the graft's rim revascularization and incorporation; however, it cannot detect or predict junction healing or occurrence of complications. Supplementary treatment of unhealed junctions showing either decreased junctional uptake or graft quiescence may be warranted. Otherwise, detection of distant metastasis and early local recurrence remains the main application of Tc99m scanning in the management of bone sarcomas.
随着巴氏消毒法在保肢重建中越来越广泛地应用，需要更多的研究来了解宿主-移植物交界处的愈合、移植物再血管化和植入，以及巴氏消毒自体移植物的并发症发生率和类型。这主要是通过随访 X 光片来实现的。我们旨在明确 Tc99m 骨扫描是否可以被认为是确定这三个参数的可靠方法。
回顾性分析了 27 例接受巴氏消毒自体骨重建的骨肉瘤患者，术后每 6 个月进行一次放射性核素骨扫描和 X 光片随访，随访时间为 36 个月。对未愈合的病例进行了最长随访，随访时间超过了原始研究时间，范围为 1 至 15 个月。Tc99m 摄取被分为冷、淡、中和高摄取。交界愈合被分为无、部分和完全愈合。
70%的交界在 22 个月时愈合。90%至 100%的交界在研究期间的某个时间显示出高或中摄取（无论最终结果如何）。85%的巴氏消毒移植物显示出特征性的“铁轨样外观”。4 个移植物（15%）出现并发症：假关节和植入物失败（1 个）、钢板断裂（1 个）、髓内钉（IMN）断裂（1 个）和宿主骨内假体柄松动（1 个），所有病例的未愈合交界都存在潜在的并发症。
骨扫描可以确定移植物边缘再血管化和植入的阶段；然而，它不能检测或预测交界愈合或并发症的发生。对于显示交界摄取减少或移植物静止的未愈合交界，可能需要进行补充治疗。否则，检测远处转移和早期局部复发仍然是 Tc99m 扫描在骨肉瘤管理中的主要应用。
