Burdge D R, Gribble M J
Department of Medicine, University Hospital-Shaughnessy Site, University of British Columbia, Vancouver, Canada.
Am J Phys Med Rehabil. 1993 Dec;72(6):386-9.
Pressure sores are common in patients with spinal cord injury, stroke or debilitating medical illness. Contiguous osteomyelitis is a well recognized complication of pressure ulcers, but remains a challenging diagnostic and management problem. Technetium bone scan is purported to be an extremely sensitive, although nonspecific diagnostic test for osteomyelitis. Indeed, a negative bone scan is thought to virtually exclude bone infection. We report three cases of pressure sore-related polymicrobial osteomyelitis where technetium bone scan was normal, yet bone biopsy demonstrated characteristic histopathologic changes of osteomyelitis. These cases raise questions regarding the sensitivity of bone scanning in the setting of pressure sores, and they demonstrate the need for further investigation into the correlation between nuclear medicine scan results and bone biopsy histopathology. Bone biopsy remains the gold standard for diagnosis of osteomyelitis, which can be present in bone underlying a pressure ulcer, even in the setting of a normal bone scan.
压疮在脊髓损伤、中风或患有使人衰弱的疾病的患者中很常见。相邻部位的骨髓炎是压疮公认的并发症，但仍然是一个具有挑战性的诊断和管理问题。锝骨扫描据称是一种对骨髓炎极为敏感的诊断测试，尽管它不具有特异性。实际上，骨扫描结果为阴性被认为几乎可以排除骨感染。我们报告了3例与压疮相关的多微生物骨髓炎病例，这些病例的锝骨扫描结果正常，但骨活检显示出骨髓炎的典型组织病理学变化。这些病例引发了关于在压疮情况下骨扫描敏感性的问题，并且表明有必要进一步研究核医学扫描结果与骨活检组织病理学之间的相关性。骨活检仍然是诊断骨髓炎的金标准，即使在骨扫描正常的情况下，压疮下方的骨骼也可能存在骨髓炎。
