Yue Bing, Tang Tingting
Shanghai Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Nucl Med Commun. 2015 Apr;36(4):305-11. doi: 10.1097/MNM.0000000000000266.
Periprosthetic infection and aseptic prosthesis loosening remain the most common and serious complications of total hip arthroplasty and total knee arthroplasty. The differentiation of septic from aseptic prosthetic loosening is of great importance because the treatment of the two conditions is vastly different. Anatomical imaging procedures such as conventional radiography, computed tomography, or MRI are unable to differentiate septic and aseptic loosening, mainly because of hardware-induced artifacts. Nuclear imaging, however, reflects functional rather than anatomical changes and is not hampered by the presence of a metallic prosthesis. The commonly used nuclear imaging techniques include triple-phase bone scintigraphy, 67Ga, leukocyte scintigraphy, leukocyte/bone marrow scintigraphy, monoclonal antibodies/antibody fragments, radiolabeled ciprofloxacin, antimicrobial peptides, etc. Besides infection detection, single-photon emission computed tomography (SPECT) and PET with computed tomography (SPECT/CT and PET/CT) provide additional information on the location of the infection foci, which is clinically important for surgeons to select the most appropriate treatment and guide the intraoperative clearance of the infection foci. The current review will describe the working mechanism, clinical practice, and pros and cons of these techniques in the evaluation of periprosthetic infection.
人工关节周围感染和无菌性假体松动仍然是全髋关节置换术和全膝关节置换术最常见且最严重的并发症。区分感染性与无菌性假体松动至关重要，因为这两种情况的治疗方法截然不同。传统X线摄影、计算机断层扫描或磁共振成像等解剖学成像检查无法区分感染性和无菌性松动，主要原因是金属植入物产生的伪影。然而，核成像反映的是功能变化而非解剖学变化，并且不受金属假体存在的影响。常用的核成像技术包括三相骨闪烁显像、67Ga、白细胞闪烁显像、白细胞/骨髓闪烁显像、单克隆抗体/抗体片段、放射性标记环丙沙星、抗菌肽等。除了感染检测外，单光子发射计算机断层扫描（SPECT）以及与计算机断层扫描联用的正电子发射断层显像（SPECT/CT和PET/CT）可提供有关感染灶位置的额外信息，这对于外科医生选择最合适的治疗方法以及指导术中清除感染灶具有重要临床意义。本综述将描述这些技术在评估人工关节周围感染中的工作机制、临床应用及优缺点。
