Wukich D K, Abreu S H, Callaghan J J, Van Nostrand D, Savory C G, Eggli D F, Garcia J E, Berrey B H
Orthopaedic Surgery Service, Walter Reed Army Medical Center, Washington, D.C. 20307-5001.
J Bone Joint Surg Am. 1987 Dec;69(9):1353-60.
Scintigraphy with indium-labeled white blood cells has been reported to be sensitive and specific in the diagnosis of low-grade sepsis of the musculoskeletal system. We reviewed the records of fifty patients who had suspected osteomyelitis or suspected infection about a total joint prosthesis and who underwent scintigraphy with technetium-99m methylene diphosphonate and scintigraphy with indium-111 oxine-labeled white blood cells before an open surgical procedure. Any patient who received preoperative antibiotics was not included in the study. For all of the patients, gram-stain examination of smears, evaluation of a culture of material from the operative site, and histological examination were done. The patients were divided into two groups. Group I was composed of twenty-four patients, each of whom had a prosthesis in place and complained of pain. Group II was composed of twenty-six patients for whom a diagnosis of chronic osteomyelitis had to be considered. With the indium scans alone, there was only one false-negative result (in Group II), but there were eighteen false-positive results (eight patients in Group II and ten patients in Group I). Although scintigraphy with indium-labeled white blood cells is quite sensitive, it is not specific in detecting chronic osteomyelitis; a negative scan should be considered highly suggestive that osteomyelitis is not present. Specificity can be increased by interpreting the indium scan in conjunction with the technetium scan.
据报道，铟标记白细胞闪烁扫描术在诊断肌肉骨骼系统的低度脓毒症方面具有敏感性和特异性。我们回顾了50例疑似骨髓炎或疑似人工关节假体感染的患者记录，这些患者在进行开放性手术前接受了锝-99m亚甲基二膦酸盐闪烁扫描术和铟-111氧嗪标记白细胞闪烁扫描术。所有接受术前抗生素治疗的患者均未纳入本研究。对所有患者进行了涂片革兰氏染色检查、手术部位取材培养评估及组织学检查。患者被分为两组。第一组由24例患者组成，他们均有人工关节假体且主诉疼痛。第二组由26例患者组成，他们均需考虑慢性骨髓炎的诊断。仅通过铟扫描，仅有1例假阴性结果（在第二组），但有18例假阳性结果（第二组8例患者，第一组10例患者）。尽管铟标记白细胞闪烁扫描术相当敏感，但在检测慢性骨髓炎方面并不具有特异性；阴性扫描结果应被视为强烈提示不存在骨髓炎。通过结合锝扫描来解读铟扫描可提高特异性。
