Lee Seung Hoo, Kim Min Bom
Department of Orthopaedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, South Korea.
Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea.
Int Orthop. 2023 Jan;47(1):5-15. doi: 10.1007/s00264-022-05617-5. Epub 2022 Nov 12.
This study was performed to investigate the feasibility of bone single-photon emission tomography/computed tomography (SPECT/CT) for pre-operative planning of chronic osteomyelitis (COM) of the lower extremities by localization of osteomyelitis lesions.
From January 2016 to January 2020, we surgically treated ten adult patients with Cierny-Mader type III COM in the tibia or femur for a mean duration of 24.4 months (range 7.0-70.0 months). We conducted pre-operative planning by bone SPECT/CT and localization of osteomyelitis lesions. The treatment consisted of intra-operative eradication of the infective focus and antibiotic administration. The clinical and radiological outcomes were retrospectively analyzed after a minimum of one year of follow-up.
The patients were surgically treated by thorough debridement, dead space management, and appropriate antibiotics without bone transport or an external fixator. The location of the hot uptake region on bone SPECT/CT coincided with that of the osteomyelitis lesion, which was confirmed intra-operatively in all patients. At an average of 16.5 ± 4.3 months (range, 13.0-25.0 months), clinical eradication of osteomyelitis was achieved in nine of the ten patients. One patient required amputation due to recurrence of osteomyelitis. A successful clinical outcome was achieved in eight patients; one suffered persistent ankle pain due to a destructive change in the ankle joint despite eradication of the infection.
Bone SPECT/CT is a feasible method for the localization and eradication of osteomyelitis lesions in COM of the lower extremities and has favourable clinical outcomes. It can also be applied in cases of distorted bony structures caused by previous trauma or surgery, or in the presence of implants.
本研究旨在通过对骨髓炎病灶进行定位，探讨骨单光子发射断层扫描/计算机断层扫描（SPECT/CT）在下肢慢性骨髓炎（COM）术前规划中的可行性。
2016年1月至2020年1月，我们对10例患有胫骨或股骨Cierny-Mader III型COM的成年患者进行了手术治疗，平均病程为24.4个月（范围7.0 - 70.0个月）。我们通过骨SPECT/CT和骨髓炎病灶定位进行术前规划。治疗包括术中根除感染灶和使用抗生素。在至少随访一年后，对临床和影像学结果进行回顾性分析。
患者接受了彻底清创、死腔处理和适当抗生素的手术治疗，未进行骨搬运或使用外固定器。骨SPECT/CT上热摄取区域的位置与骨髓炎病灶的位置一致，所有患者术中均得到证实。平均16.5±4.3个月（范围13.0 - 25.0个月）时，10例患者中有9例实现了骨髓炎的临床根除。1例患者因骨髓炎复发需要截肢。8例患者取得了成功的临床结果；1例患者尽管感染已根除，但由于踝关节破坏性改变仍持续存在踝关节疼痛。
骨SPECT/CT是一种用于定位和根除下肢COM中骨髓炎病灶的可行方法，具有良好的临床效果。它也可应用于既往创伤或手术导致骨结构扭曲或存在植入物的病例。
