Racionalna i pouzdana dijagnoza periprotetske infekcije kuka i kolena korišćenjem dve nuklearno-medicinske metode: 99mTc-ciprofloksacin i 99mTc-MDP scintigrafije
Sažetak
Uvod/Cilj. Postoji dramatičan i konstantan porast ugradnje novih proteza kuka i kolena širom sveta. Međutim, procenat neuspelih (inficiranih) protetskih implantacija se ne smanjuje značajno (0,5% do 2%). Pravi izazov je pitanje da li je nastalo razlabavljenje protetskog zgloba uzrokovano aseptičnom upalom ili infekcijom. Cilj studije bio je pokušaj odvajanja sterilne upale od infekcije kod bolesnika sa bolnim protetskim zglobovima kuka ili kolena. Pored toga, naš cilj je bio da utvrdimo tačnost kombinovane scintigrafije kostiju metilendifosfonatom (MDP) i ciprofloksacinom u dijagnostici periprotetske infekcije zglobova (PJI). Metode. Korišćena je trofazna scintigrafija kostiju sa 99mTc-MDP i 99mTc-ciprofloksacin. Kriterijum za odabir bolesnika za ovo istraživanje bila je sumnja na PJI praćenu bolom i ograničenim pokretima protetskog zgloba uz povišenje nespecifičnih faktora upale. Uključeno je i procenjeno 45 bolesnika sa implantiranih 39 proteza kuka i 24 proteze kolena. Pregledani su svi protetski zglobovi (iako su neki zglobovi bili asimptomatski) i kod svih je bila urađena planarna radiografija. Vremenski razmak između izvedenih
nuklearno-medicinskih metoda iznosio je u proseku 3–5 dana. Prvo je izvođena trofazna 99mTc-MDP scintigrafija kostiju. Scintigrafiju 99mTc-ciprofloksacinom obavezno je pratilo izračunavanje indeksa akumulacije. Dobijeni rezultati su bili potvrđeni mikrobiološkim nalazima kao zlatnim standardom. Statistička analiza dobijenih rezultata urađena je pomoću softvera SPSS, verzija 20 (deskriptivna statistika, χ2-test). Takođe su bili izračunati osetljivost, specifičnost i prediktivne vrednosti. Rezultati. Mikrobiološki potvrđene PJI bile su prisutne kod 16 od 39 proteza kuka. Pozitivna scintigrafija je dobijena kod 15 od 39 proteza kuka. Scintigrafija kolena je bila pozitivna kod svih 13 od 24 protetska zgloba kolena koji su imali mikrobiološku potvrdu PJI. Izračunata osetljivost/specifičnost za 99mTc-MDP scintigrafiju kosti (za oba zgloba) iznosila je 90%/69%, za 99mTc-ciprofloksacin scintigrafiju 93%/97%, a za kombinaciju obe scintigrafije 96,5%/97%. Zaključak. Kombinovana scintigrafija sa 99mTc-MDP i 99mTc-ciprofloksacinom povećava sposobnost razlikovanja aseptičnog labavljenja protetskog zgloba od PJI sa visokom tačnošću od 97%.
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