Department of Orthopedic Surgery, ShangHai YangPu District Central Hospital, YangPu Hospital, TongJi University.
Department of Orthopaedic Surgery, Pudong New Area Poeples' Hospital, Shanghai University of Medicine and Health Sciences.
Nucl Med Commun. 2021 Mar 1;42(3):244-252. doi: 10.1097/MNM.0000000000001323.
Hip pain arising from implant instability is generally caused by repetitive stress injury, which subsequently leads to induction or exacerbation of abnormal metabolism of bone around the implant. single photon emission tomography/computed tomography (SPECT-CT) has advantages in localizing areas of increased tracer uptake that reflects such abnormal bone metabolism. Therefore, we investigated whether the application of SPECT/CT with stress analysis can be an effective practice in evaluating the instability of stem in noncemented hip arthroplasty or not.
In total 16 patients were collected for unexplained painful hip arthroplasties. When physical examination and blood tests were unremarkable, radiographs were inconclusive and bone scan indicated increased scintigraphic uptake at the proximal part and at the tip of the stem; SPECT/CT was performed. Stem stability was assessed by measuring whether there was consistency between the increased scintigraphic uptake and the direction of the stress around the implant along with the location of the prosthesis.
Among the 16 symptomatic hips, 9 hips showed the stability of the stem, 3 hips showed the stem instability and 4 hips showed the acetabular loosening with the stem stability. With the application of SPECT/CT with stress analysis, 15 out of 16 (93.7%) cases were found to have the change in the diagnoses, and managements were implemented in 11 out of 16 (68.7%) cases. When comparing before and after SPECT/CT, there was no significant association in clinical diagnosis and management (Pearson chi- square test = 4.61 and 1.33, P = 0.33 and 0.25).
SPECT/CT combined with stress analysis can be a useful tool in early diagnosis of stem instability and can assist surgeons in subsequent management and decision implementation when other radiographic imagings are inconclusive.
由假体不稳定引起的髋部疼痛通常是由反复的应力损伤引起的，这会导致假体周围骨的异常代谢的诱导或加重。单光子发射断层扫描/计算机断层扫描（SPECT-CT）在定位反映这种异常骨代谢的示踪剂摄取增加的区域方面具有优势。因此，我们研究了 SPECT/CT 结合应力量分析是否可以有效地评估非骨水泥髋关节置换术后假体的不稳定。
共收集了 16 例原因不明的髋部疼痛性人工关节置换患者。当体格检查和血液检查无异常，影像学检查不确定，骨扫描提示假体近端和尖端的放射性摄取增加时，进行 SPECT/CT 检查。通过测量放射性摄取增加的位置与假体周围的应力方向之间的一致性，评估假体的稳定性。
在 16 例有症状的髋关节中，9 例假体稳定，3 例假体不稳定，4 例髋臼松动但假体稳定。应用 SPECT/CT 结合应力量分析，16 例中有 15 例（93.7%）的诊断发生了改变，其中 11 例（68.7%）进行了相应的处理。SPECT/CT 前后比较，临床诊断和处理无显著相关性（Pearson 卡方检验=4.61 和 1.33，P=0.33 和 0.25）。
SPECT/CT 结合应力量分析可以成为早期诊断假体不稳定的有用工具，当其他影像学检查不确定时，可帮助外科医生进行后续处理和决策实施。
