Bernstein P, Beuthien-Baumann B, Kotzerke J, Hofheinz F, Zessin J, Stiehler M, Günther K-P
Dr. med. Peter Bernstein, Facharzt, Klinik und Poliklinik für Orthopädie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307 Dresden, http://www.uniklinikum-dresden.de, E-mail:
Nuklearmedizin. 2014 Aug 6;53(4):147-54. doi: 10.3413/Nukmed-0607-13-06. Epub 2014 Feb 28.
The treatment of loosened total hip replacement (THR) acetabular components may require the management of severe bone defects. Although being applied for decades, there is only limited scientific data about the osteointegration of cancellous bone allografts (CBA) and other void fillers. Monitoring of periprosthetic bone regeneration could possibly help to optimize this process thereby reducing late failure rates. The aim of this study was to show osteometabolic changes in periprosthetic CBA after THR revision with the use of sodium-[18F]-fluoride (NaF) and positron emission tomography (PET).
PATIENTS, METHODS: Twelve patients undergoing THR revision with the use of CBA were prospectively enrolled in the study. Nine patients completed all necessary examinations and were included in the evaluation. The temporal pattern of osteointegration was assessed via NaF-PET at one (PET1) and six weeks (PET2) after surgery. CBA, tantalum implants, supraacetabular regions ipsilateral and contralateral, and parasymphyseal pubic bones were delineated as volumes of interest (VOI) in postop CT scans, which were then merged with the PET data.
In comparison to the contralateral supraacetabular reference bone, a significant 1.5-fold increase of osteometabolic activity from PET1 to PET2 was seen in the CBA region. Also, the ipsilateral supraacetabular host bone showed a higher NaF-influx in week 6, compared to the first postoperative week. The supraacetabular site exhibited a significantly 1.8- to 2-fold higher influx and uptake than bone regions in non-operated sites. Tantalum implants had a low NaF influx at both time points investigated.
Using NaF-PET osteometabolic changes of CBA and implant-bone-interfaces can be monitored. Applying this method we demonstrated early periprosthetic temporal bone regeneration patterns in THR cup revision patients.
全髋关节置换术（THR）髋臼组件松动的治疗可能需要处理严重的骨缺损。尽管已应用数十年，但关于松质骨同种异体骨（CBA）和其他骨缺损填充材料骨整合的科学数据有限。监测假体周围骨再生可能有助于优化这一过程，从而降低晚期失败率。本研究的目的是利用[18F] - 氟化钠（NaF）和正电子发射断层扫描（PET）显示THR翻修术后假体周围CBA的骨代谢变化。
患者、方法：12例接受使用CBA进行THR翻修术的患者前瞻性纳入本研究。9例患者完成了所有必要检查并纳入评估。术后1周（PET1）和6周（PET2）通过NaF - PET评估骨整合的时间模式。在术后CT扫描中将CBA、钽植入物、同侧和对侧髋臼上区域以及耻骨联合旁骨划定为感兴趣区（VOI），然后将其与PET数据合并。
与对侧髋臼上参考骨相比，CBA区域从PET1到PET2骨代谢活性显著增加1.5倍。此外，同侧髋臼上宿主骨在术后第6周显示出比术后第一周更高的NaF流入量。髋臼上部位的流入量和摄取量比未手术部位的骨区域显著高1.8至2倍。在两个研究时间点钽植入物的NaF流入量都很低。
使用NaF - PET可以监测CBA和植入物 - 骨界面的骨代谢变化。应用该方法我们证明了THR髋臼翻修患者假体周围早期的骨再生时间模式。
