Vaz Sofia, Ferreira Teresa C, Salgado Lucília, Paycha Frédéric
Nuclear Medicine Department, Instituto Português de Oncologia Francisco Gentil, E.P.E. Lisbon, Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal.
Nuclear Medicine Department, Hôpital Lariboisière Assistance Publique-Hôpitaux de Paris, rue Ambroise-Paré 75475, Paris Cedex 10, France.
Eur J Orthop Surg Traumatol. 2017 Feb;27(2):147-156. doi: 10.1007/s00590-016-1884-6. Epub 2016 Nov 30.
In recent years, with the higher median life expectancy, the number of hip and knee replacements has increased. Clinical examination and morphological studies are essential to evaluate patients with a painful arthroplasty. Nuclear medicine examinations also play an important role, their main usefulness being the exclusion of prosthesis complications. Nevertheless, conventional examinations, namely bone scan and white blood cell scintigraphy, can also identify complications, such as loosening and infection. This study describes the normal and pathologic patterns of a bone scan and exemplifies ten common situations that can cause pain in patients with hip or knee arthroplasty, other than loosening and infection, which can be disclosed on a bone scintigraphy. The ten situations that should be considered and looked for when analysing a bone scan are: referred pain, patellofemoral pain syndrome, fractures, fissures, abscess/haematoma, bone insert behaviour, heterotopic ossification, greater trochanter pseudarthrosis, osteoarthritis extension in a knee with an unicompartmental prosthesis, and systemic disease with bone involvement.
近年来，随着中位预期寿命的提高，髋关节和膝关节置换手术的数量有所增加。临床检查和形态学研究对于评估接受关节置换手术且感到疼痛的患者至关重要。核医学检查也发挥着重要作用，其主要用途是排除假体并发症。然而，传统检查，即骨扫描和白细胞闪烁扫描，也能够识别诸如松动和感染等并发症。本研究描述了骨扫描的正常和病理模式，并举例说明了十种除松动和感染外可导致髋关节或膝关节置换患者疼痛的常见情况，这些情况可在骨闪烁扫描中被发现。分析骨扫描时应考虑并查找的十种情况为：牵涉痛、髌股疼痛综合征、骨折、骨裂、脓肿/血肿、骨植入物表现、异位骨化、大转子假关节、单髁膝关节置换术后膝关节骨关节炎扩展以及累及骨骼的全身性疾病。
