-
骨折是临床的常见病、多发病,其愈合过程受多种因素的影响,准确判断骨折愈合情况,对骨折患者制定科学的康复锻炼计划、确定内固定物取出时间以及是否需要二次手术等具有重要临床意义。参考骨折的临床愈合标准[1]和延迟愈合或不愈合标准[2],多数骨折愈合情况的诊断较容易,但部分诊断为延迟愈合或不愈合的骨折,可能仍具有远期愈合的潜力,准确评价该类骨折的远期愈合能力可明确判断患者是否需要再次手术。笔者应用99Tcm -MDP SPECT/CT融合骨显像对76例未达到骨折临床愈合标准的患者进行骨折远期愈合能力评价,现总结报道如下。
99Tcm-MDP SPECT/CT融合骨显像评价骨折远期愈合能力的应用价值
Evaluation of fracture healing by 99Tcm-MDP SPECT/CT
-
摘要:
目的探讨99Tcm-MDP SPECT/CT融合骨显像技术评价骨折远期愈合能力的应用价值。 方法回顾性分析2008年1月至2017年8月在我院治疗至少超过6个月的76例骨折患者的影像资料,其中58例经手术治疗,18例采用非手术方法治疗,所有骨折患者均未达到临床愈合标准。对76例骨折患者行SPECT显像、CT扫描和SPECT/CT融合骨显像,分析骨折端的放射性分布及CT特征,观察骨折端放射性浓聚是否连续性通过骨折线,跨越两侧骨折端,评价骨折远期愈合能力,最终骨折愈合情况经临床随访或手术证实。 结果76例骨折患者,58例SPECT/CT融合骨显像显示放射性浓聚连续性通过骨折线并跨越两侧骨折端,诊断为骨折具有远期愈合能力,经对症保守治疗,证实52例骨折远期愈合,6例未愈合,SPECT/CT对骨折远期愈合诊断的准确率达89.66%(52/58)。18例骨折端未见明显连续性通过骨折线的放射性浓聚,诊断为骨折不愈合,且不具备远期愈合能力,均进行了手术治疗并证实为骨折不愈合,SPECT/CT对骨折远期不愈合诊断的准确率达100%(18/18)。 结论SPECT/CT融合骨显像可较准确地评价骨折的远期愈合能力,具有重要的临床应用价值。 -
关键词:
- 骨折愈合 /
- 单光子发射计算机体层摄影术 /
- 亚甲基二膦酸盐
Abstract:ObjectiveTo explore the application value of SPECT/CT on fracture healing. MethodsA retrospective analysis was done among 76 patients with fracture as evidenced by image data from January 2008 to August 2017. Fifty-eight cases with fracture revealed by a SPECT/CT fusion image with surgical treatment, 18 cases with nonsurgical treatment, and 76 cases of bone fracture clinical healing that failed to meet standards were retrospectively analyzed after more than 6 months of treatment. A SPECT/CT image fusion imaging device was applied to 76 cases of fracture detected with SPECT, CT scan, and SPECT/CT fusion imaging. The characteristics of the fractures in terms of radioactive distribution and CT were examined, and the radioactive strength of the fracture was observed to determine whether radioactivity passed continuously through the fracture line or crossed both sides of the fracture. The healing ability of the fracture was evaluated, and fracture healing cases were confirmed through surgery or clinical follow-up. ResultsA total of 76 fractures were collected and examined through SPECT/CT, and 58 cases of uptake that passed through the fracture line and crossed on both sides of the fracture end were obtained. This finding indicated that the fracture was in the process of healing and that fracture could heal. Furthermore, 52 cases were confirmed after conservative treatment was administered, and 6 cases of fracture were nonunion. For 18 cases, no nuclide concentration was detected in the fracture end, and the fracture was nonunion. The final diagnosis was confirmed through surgery, and the diagnostic accuracy rates were 89.66%(52/58) for fracture healing and 100%(18/18) for nonunion. ConclusionSPECT/CT imaging could accurately evaluate fracture healing and had an important application value. -
图 1 股骨骨折交锁髓内钉术后患者(男性,29岁)的DR、CT和SPECT/CT图 术后7个月股骨侧位DR片(A)及CT矢状位多平面重建图像(B),显像示骨折线清楚,边缘可见少量骨痂,但未连续性通过骨折线,诊断为骨折延迟愈合;C:SPECT/CT融合骨显像,显像示放射性浓聚连续通过骨折线并跨越两侧骨折端,提示骨折具有远期愈合能力;D:随访股骨侧位片,临床对症治疗、随访8个月后复查,骨折愈合。SPECT/CT:单光子发射计算机体层摄影术;DR:数字化X线摄影。
Figure 1. The DR, CT, SPECT/CT of patients with femoral fracture after interlocking intramedullary nail surgery
图 2 股骨骨折钢板内固定术后患者(男性,20岁)的DR、CT和SPECT/CT图 图中,A、B:术后半年股骨侧位DR片(A)及CT矢状位多平面重建图像(B),显像示骨折线清楚,骨折端未见明显骨痂形成,诊断为骨折迟延愈合;C:SPECT/CT融合骨显像,显像示放射性浓聚连续通过骨折线并跨越两侧骨折端,提示骨折具有远期愈合能力;D:随访股骨侧位片,临床对症治疗、随访半年后复查,骨折愈合。SPECT/CT:单光子发射计算机体层摄影术;DR:数字化X线摄影。
Figure 2. The DR, CT, SPECT/CT of patients with femoral fracture after plate internal fixation surgery
图 3 股骨骨折术后患者(男性,30岁)的CT及SPECT/CT显像图 图中,A、B:术后1年CT冠状位(A)及矢状位(B)多平面重建图像,图像示骨折线清楚,骨折端骨质硬化、封闭骨髓腔,周围未见明显骨痂形成,诊断为骨折不愈合;C:SPECT/CT融合骨显像,图像示远侧骨折端可见局限性放射性浓聚,未连续性通过骨折线,未跨越两侧骨折端,提示骨折不具有远期愈合能力,经手术治疗证实。SPECT/CT:单光子发射计算机体层摄影术;CT:计算机体层摄影术。
Figure 3. CT and SPECT/CT images of patients with femoral fracture after surgery
图 4 股骨骨折交锁髓内钉固定术后患者(男性,35岁)的DR、CT及SPECT/CT图 图中,A、B:术后15个月DR正位片(A)及CT矢状位多平面重建图像(B),图像示骨折线清楚,骨折远端骨质吸收,密度减低,骨折端周围可见骨痂形成,但未连续通过骨折线,诊断为骨折不愈合;C:SPECT/ CT融合骨显像,图像示两侧骨折端均可见放射性浓聚,但未连续性通过骨折线,未跨越两侧骨折端,提示骨折不具有远期愈合能力,经手术治疗证实。DR:数字化X线摄影;SPECT/CT:单光子发射计算机体层摄影术;CT:计算机体层摄影术。
Figure 4. DR, CT and SPECT/CT images of patients with femoral fracture after interlocking intramedullary nail surgery
-
[1] 吴作培, 孙贵新.骨不连治疗的研究与技术应用进展[J].中国组织工程研究, 2013, 17(35):6333-6338. DOI:10.3969/j.issn.2095-4344.2013.35.018.
Wu ZP, Sun GX. Progress of research and technology application of the treatment of fracture nonunion[J]. J Clin Rehabil Tis Eng Res, 2013, 17(35):6333-6338. doi: 10.3969/j.issn.2095-4344.2013.35.018[2] 韩萍, 于春水.医学影像诊断学[M].北京:人民卫生出版社, 2017:560-561.
Han P, Yu CS. Diagnosic Medical Imaging[M]. Beijing:People's Medical Publishing House, 2017:560-561.[3] 张建媛, 尤立强.临床愈合期后骨折部位核素骨显像表现分析[J].医学信息, 2014, 27(3):66-67. DOI:10.3969/j.issn.1006-1959. 2014.03.076.
Zhang JY, You LQ. Analysis of radionuclide bone imaging performance of fracture after the clinical healing period[J]. Med Inf, 2014, 27(3):66-67. doi: 10.3969/j.issn.1006-1959.2014.03.076[4] 张敏, 刘玉珂, 陈亚玲, 等.应用图像融合技术诊断骨折愈合——图像融合技术在骨与关节疾病诊断中的应用(二)[J].中医正骨, 2010, 22(10):22-24. DOI:10.3969/j.issn.1001-6015. 2010.10.007.
Zhang M, Liu YK, Chen YL, et al. Diagnosis of fracture healing by image fusion-application of image fusion in the diagnosis of bone and joint diseases[J]. J Tradit Clin Orthop Traumatol, 2010, 22(10):22-24. doi: 10.3969/j.issn.1001-6015.2010.10.007[5] 张斌青, 宋青凤, 王军辉, 等. SPECT/CT显像对骨折延迟愈合的诊断价值[J].中华核医学与分子影像杂志, 2014, 34(4):305-307. DOI:10.3760/cma.j.issn.2095-2848.2014.04.009.
Zhang BQ, Song QF, Wang JH, et al. Diagnostic value of SPECT/CT for fracture delayed union[J]. Chin J Nucl Med Mol Imaging, 2014, 34(4):305-307. doi: 10.3760/cma.j.issn.2095-2848.2014.04.009[6] 贠新泉, 刘学军, 葛丽红, 等. 放射性核素骨显像和SPECT/CT断层融合显像技术在骨折愈合过程中的应用及预后研究[J/OL]. 临床医药文献电子杂志, 2017, 4(22): 4297[2018-03-11]. hppt://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcyydzzz201722109. DOI:10.3877/j.issn.2095-8242.2017.22.109.
Yun XQ, Liu XJ, Ge LH, et al. Application of SPECT and SPECT/CT in fracture healing and prognosis[J/OL]. J Clin Med Lit(Electronic Edition), 2017, 4(22): 4297[2018-03-11]. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcyydzzz201722109.[7] 刘鸿麒, 丁真奇.临床研究中骨折愈合过程的评价方法进展[J].中国现代医生, 2010, 48(4):43-44, 59. DOI:10.3969/j.issn.1673-9701.2010.04.018.
Liu HQ, Ding ZQ. Progress in evaluation of fracture healing in clinical studies[J]. Chin Modern Doctor, 2010, 48(4):43-44, 59. doi: 10.3969/j.issn.1673-9701.2010.04.018[8] 张斌青, 宋青凤, 刘玉珂, 等. 99Tcm-MDP SPECT/CT图像融合诊断隐匿性骨折[J].中国医学影像技术, 2014, 30(4):587-590. DOI:10.13929/j.1003-3289.2014.04.052.
Zhang BQ, Song QF, Liu YK, et al. 99Tcm-MDP SPECT/CT fusion in diagnosis of occult bone fractures[J]. Chin J Med Imaging Technol, 2014, 30(4):587-590. doi: 10.13929/j.1003-3289.2014.04.052[9] Hamann M, Aldridge M, Dickson J, et al. Evaluation of a low-dose/slow-rotating SPECT-CT system[J]. Phys Med Biol, 2008, 53(10):2495-2508. DOI:10.1088/0031-9155/53/10/003. [10] Zhao Z, Li L, Li F, et al. Single photon emission computed tomography/spiral computed tomography fusion imaging for the diagnosis of bone metastasis in patients with known cancer[J]. Skeletal Radiol, 2010, 39(2):147-153. DOI:10.1007/s00256-009-0764-0. [11] 叶谦, 董海锋, 王卫伟, 等.放射性核素骨显像在骨折诊断中的应用[J].创伤外科杂志, 2007, 9(6):530-533. DOI:10.3969/j.issn.1009-4237.2007.06.016.
Ye Q, Dong HF, Wang WW, et al. Application of radionuclide bone imaging in the diagnosis of fracture[J]. J Traum Surg, 2007, 9(6):530-533. doi: 10.3969/j.issn.1009-4237.2007.06.016[12] 张斌青, 刘玉珂, 郭会利, 等. 99Tcm-MDP SPECT/CT诊断骨骺早闭[J].中国医学影像技术, 2014, 30(10):1557-1560. DOI:10.13929/j.1003-3289.2014.10.032.
Zhang BQ, Liu YK, Guo HL, et al. 99Tcm-MDP SPECT/CT in diagnosing early closure of epiphyseal[J]. Chin J Med Imaging Technol, 2014, 30(10):1557-1560. doi: 10.13929/j.1003-3289.2014.10.032[13] 高建青, 魏玲格, 傅鹏, 等.放射性核素骨显像对骨肿瘤样病变的影像学研究价值[J].国际放射医学核医学杂志, 2014, 38(4):266-270. DOI:10.3760/cma.j.issn.1673-4114.2014.04.014.
Gao JQ, Wei LG, Fu P, et al. Value of imaging research in tumor-like disorders by radionuclide bone imaging[J]. Int J Radiat Med Nucl Med, 2014, 38(4):266-270. doi: 10.3760/cma.j.issn.1673-4114.2014.04.014[14] Liodakis E, Liodaki E, Krettek C, et al. Can the viability of a nonunion be evaluated using SPECT/CT? A preliminary retrospective study[J]. Technol Health Care, 2011, 19(2):103-108. DOI:10.3233/THC-2011-0617. [15] Rager O, Schaller K, Payer M, et al. SPECT/CT in differentiation of pseudarthrosis from other causes of back pain in lumbar spinal fusion:report on 10 consecutive cases[J]. Clin Nucl Med, 2012, 37(4):339-343. DOI:10.1097/RLU.0b013e318239248b. [16] 曹克勇, 方彩莲, 叶积飞.不同强度的早期负重对股骨干骨折愈合的影响[J].中国康复, 2014, 29(6):458-459. DOI:10.3870/zgkf.2014.06.021.
Cao KY, Fang CL, Ye JF. Effect of early loading of different strength on femoral shaft fracture healing[J]. Chin J Rehabil, 2014, 29(6):458-459. doi: 10.3870/zgkf.2014.06.021