Pin P G, Semenkovich J W, Young V L, Bartell T, Crandall R E, Gilula L A, Reed K, Weeks P M, Siegel B A
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO 63110.
J Hand Surg Am. 1988 Nov;13(6):810-4. doi: 10.1016/0363-5023(88)90252-3.
The cause of hand and wrist pain can be difficult to determine, especially when standard radiographs are normal or show only nonspecific changes. This study reports the effectiveness of radionuclide imaging in the evaluation of patients with hand and wrist pain of uncertain cause. Eighty-eight patients with hand and wrist pain and initially normal standard radiographs were evaluated prospectively by additional radiographic methods including the following: routine tomography, wrist arthrography, computerized tomography, or magnetic resonance imaging. Each patient also had bone scintigraphy. The diagnosis established by clinical assessment and by other imaging methods was then compared with the scintigraphic findings. The presence or absence of focal scintigraphic abnormalities correlated with the presence or absence of focal pathology definable by the conventional methods in 88% of patients. As expected, scintigraphy was chiefly of value in defining the locus of an injury or other process in the wrist, rather than the nature of an abnormality. The scintigrams were abnormal in 95% of cases involving complete intrinsic ligament ruptures and fractures and were normal in 96% of patients with no definable injury. Scintigraphic findings correlated poorly with partial intrinsic ligament injuries and in cases of synovitis. Radionuclide imaging is a sensitive means of detecting focal lesions in patients with hand and wrist pain of unknown cause.
手部和腕部疼痛的病因可能难以确定，尤其是当标准X线片正常或仅显示非特异性改变时。本研究报告了放射性核素成像在评估病因不明的手部和腕部疼痛患者中的有效性。对88例手部和腕部疼痛且最初标准X线片正常的患者，采用包括以下方法的额外影像学检查进行前瞻性评估：常规体层摄影、腕关节造影、计算机体层摄影或磁共振成像。每位患者均进行了骨闪烁显像。然后将临床评估及其他影像学方法确立的诊断与闪烁显像结果进行比较。在88%的患者中，闪烁显像局灶性异常的有无与传统方法可确定的局灶性病变的有无相关。正如预期的那样，闪烁显像主要在确定腕部损伤或其他病变的部位方面有价值，而非异常的性质。在涉及完全性内在韧带断裂和骨折的病例中，95%的闪烁显像异常；在无可明确损伤的患者中，96%的闪烁显像正常。闪烁显像结果与部分内在韧带损伤及滑膜炎病例的相关性较差。放射性核素成像是检测病因不明的手部和腕部疼痛患者局灶性病变的一种敏感方法。
