Zwas S T, Elkanovitch R, Frank G
J Nucl Med. 1987 Apr;28(4):452-7.
A new system for classification of stress fractures identified by bone scintigraphy was developed and divided into four grades according to lesion dimension, bone extension, and tracer accumulation. The scintigraphic findings were evaluated for severity of lesions by extent of the visualized bone response, ranging from ill-defined cortical lesions with slightly increased activity (I) to well-defined intramedullary transcortical lesions with intensely increased activity (IV). Bone scintigraphies using [99mTc]MDP were obtained in 310 military recruits suspected of having stress fractures. In 235 patients, 391 stress fractures were diagnosed. Forty percent of the lesions were asymptomatic. Most of the lesions were in the tibiae (72%), and 87% of the patients had one or two lesions, while 13% had three to five lesions. Eighty-five percent of the lesions were classified as mild and showed early and more complete resolution on follow-up studies after treatment as compared to the severe grades. Furthermore, specific scintigraphic patterns have been introduced for distinguishing inflammatory shin-splints from stress fractures, allowing for their appropriate early treatment. Thus, early recognition of mild stress fracture scintigraphic patterns representing the beginning of pathologic bone response to stress enabled a prompt and effective treatment to prevent progression of lesions, protracted disability, and complications.
开发了一种通过骨闪烁显像识别应力性骨折的新分类系统，该系统根据病变大小、骨质延伸范围和示踪剂积聚情况分为四个等级。根据可视化骨反应的程度评估闪烁显像结果中病变的严重程度，范围从不明确的皮质病变伴轻度活性增加（I级）到明确的髓内穿皮质病变伴强烈活性增加（IV级）。对310名疑似患有应力性骨折的新兵进行了使用[99mTc]MDP的骨闪烁显像检查。在235名患者中，诊断出391例应力性骨折。40%的病变无症状。大多数病变位于胫骨（72%），87%的患者有一到两处病变，13%的患者有三到五处病变。85%的病变被归类为轻度，与重度等级相比，在治疗后的随访研究中显示出早期且更完全的愈合。此外，还引入了特定的闪烁显像模式来区分炎性胫骨疼痛与应力性骨折，以便进行适当的早期治疗。因此，早期识别代表病理性骨对应力反应开始的轻度应力性骨折闪烁显像模式，能够进行及时有效的治疗，以防止病变进展、长期残疾和并发症。
