University of California Los Angeles, Los Angeles, CA, USA.
Hospital for Special Surgery, New York, NY, USA.
Foot Ankle Int. 2020 Jun;41(6):639-646. doi: 10.1177/1071100720909357. Epub 2020 Mar 10.
Evaluating pain after total ankle replacement (TAR) is often difficult, and traditional imaging modalities do not always adequately assess potential etiologies of failure. Our study adds to the current understanding of single-photon emission computed tomography combined with conventional computed tomography (SPECT-CT) as a diagnostic tool for painful TAR. We hypothesized that SPECT-CT would be predictive of clinical and intraoperative findings and would be more useful than magnetic resonance imaging (MRI) in our cohort.
A retrospective review of SPECT-CT imaging performed at our institution in patients with painful TAR from January 2014 to November 2018 was conducted. A total of 37 patients were identified, and 28 of them underwent revision surgery. Additionally, 19 patients had an MRI during the same time frame. Imaging results were compared to the documented clinical findings and intraoperative findings during revision surgery.
Of the 37 patients included, 89.2% (33/37) had SPECT-CT results that were consistent with the ultimate diagnosis documented in the medical record. Aseptic loosening (12/33) and impingement (11/33) were the most common diagnoses. Among patients who underwent revision surgery, SPECT-CT results were consistent with intraoperative findings in 26 of the 28 (92.9%) cases. In the 19 patients who also underwent MRI, the findings were consistent with clinical findings 36.8% (7/19) of the time.
In our cohort, there was high consistency between SPECT-CT results and documented clinical diagnoses. SPECT-CT also demonstrated high consistency with intraoperative findings during revision surgery. Compared with MRI, SPECT-CT proved more useful in establishing a diagnosis of pain after TAR.
Level III, comparative series.
评估全踝关节置换（TAR）后的疼痛通常较为困难，传统影像学检查方式并不总能充分评估潜在的失败原因。我们的研究增加了单光子发射计算机断层扫描结合常规计算机断层扫描（SPECT-CT）作为诊断 TAR 疼痛的工具的现有认识。我们假设 SPECT-CT 可预测临床和术中发现，并且在我们的队列中比磁共振成像（MRI）更有用。
对 2014 年 1 月至 2018 年 11 月我院因 TAR 疼痛而行 SPECT-CT 检查的患者进行回顾性研究。共确定 37 例患者，其中 28 例接受了翻修手术。此外，同一时期有 19 例患者接受了 MRI 检查。将影像学结果与翻修术中记录的临床发现和术中发现进行比较。
在纳入的 37 例患者中，89.2%（33/37）的 SPECT-CT 结果与病历中记录的最终诊断相符。无菌性松动（12/33）和撞击（11/33）是最常见的诊断。在接受翻修手术的 28 例患者中，26 例（92.9%）的 SPECT-CT 结果与术中发现相符。在同时接受 MRI 检查的 19 例患者中，MRI 检查结果与临床发现相符的概率为 36.8%（7/19）。
在我们的队列中，SPECT-CT 结果与记录的临床诊断有很高的一致性。SPECT-CT 也在翻修术中与术中发现具有很高的一致性。与 MRI 相比，SPECT-CT 在确定 TAR 后疼痛的诊断方面更有用。
III 级，比较性研究。
