Kombinovana scintigrafija kostiju sa 99mTc-MDP i 99mTc-ciprofloksacinom u razlikovanju aseptične nestabilnosti od infekcije periprotetskog tkiva zgloba kuka i kolena: preliminarna studija

  • Dragan Pucar Military Medical Academy, Institute of Nuclear Medicine, Belgrade, Serbia.
  • Zoran Janković Military Medical Academy, Institute of Nuclear Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
  • Zoran Baščarević University of Belgrade, Faculty of Medicine Institute for Orthopedic Surgery “Banjica”, Belgrade, Serbia
  • Srdjan Starčević University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic for Orthopedic Surgery and Traumatology, Belgrade, Serbia.
  • Milica Čizmić University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic of Endocrinology, Belgrade, Serbia.
  • Marija Radulović Military Medical Academy, Institute of Nuclear Medicine, Belgrade, Serbia.
  • Marija Šišić Military Medical Academy, Institute of Nuclear Medicine, Belgrade, Serbia.
  • Sanja Dugonjić Military Medical Academy, Institute of Nuclear Medicine, Belgrade, Serbia.
  • Ljiljana Jauković Military Medical Academy, Institute of Nuclear Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
  • Boris Ajdinović Military Medical Academy, Institute of Nuclear Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
DOI: https://doi.org/10.2298/VSP151211150P
Ključne reči: knee prosthesis||, ||koleno, proteza, hip prosthesis||, ||kuk, infection||, ||infekcija, diagnosis, differential||, ||dijagnoza, diferencijalna, radionuclide imaging||, ||scintigrafija, technetium tc 99m medronate||, ||tehnecijum tc 99m medronat, technetium tc 99m ciprofloxacin||, ||tehnecijum tc 99m ciprofloksacin,

Sažetak


Uvod/Cilj. Iako broj novo ugrađenih protetskih zglobova kuka i kolena svake godine raste, procenat neuspešnih artroplastika ostaje približno isti. Kao glavno pitanje nameće se, da li je u pitanju aseptična nestabilnost proteze ili je nestabilnost posledica neprepoznate infekcije. Cilj ove preliminarne studije je pokušaj da se kombinovanom upotrebom scintigrafije kostiju 99mTc obeleženim ciprofloksacinom i scintigrafije 99mTc-metilen-difosfonatom (MDP) unapredi dijagnostička tačnost razlikovanja aseptične nestabilnosti i periprotetske infekcije kod protetskih zglobova kuka i kolena. Metode. Kriterijum za ulazak u ovu studiju bio je: bol u protetskom zglobu, ograničeni pokreti u zglobu i uvećane vrednosti nespecifičnih znakova inflamacije, C-reaktivnog proteina i sedimentacije eritrocita. Ispitivanjem je obuhvaćeno 20 bolesnika sa 14 ugrađenih proteza kuka i 6 proteza kolena. Kod svih bolesnika učinjena je radiografija protetskog zgloba, kao i trofazna scintigrafija kostiju sa 99mTc-MDP. Tri do pet dana nakon scintigrafije kostiju urađena je i scintigrafija 99mTc-ciprofloksacinom sa određivanjem indeksa vezivanja. Infekcija periprotetskog tkiva je potvrđena mikrobiološkim nalazom. Rezultati. U 14 od 20 posmatranih protetskih zglobova potvrđena je infekcija, u pet slučajeva se radilo o aseptičnoj nestabilnosti protetskog zgloba, a u jednom slučaju simptomi nisu bili vezani za sam protetski zglob već je u pitanju bila loša biomehanika zgloba uzrokovana izrazitom slabošću abduktorne muskulature. Dobijena osetljivost i specifičnost za scintigrafiju kostiju pomoću 99mTc-MDP iznosila je 100% i 17%; za scintigrafiju 99mTc-ciprofloksacinom bila je 85,7% i 100%, a za kombinovani nalaz obe metode iznosila je 92,3% i 83,3%. Studija je potvrdila visoku negativnu prediktivnu vrednost scintigrafije kostiju u dijagnostici periprotetske infekcije. Drugim rečima negativna scintigrafija kostiju praktično isključuje mogućnost postojanja infekcije. S druge strane pozitivan nalaz scintigrafije kostiju ne može sa sigurnošću da potvrdi postojanje infekcije. Zaključak. Kombinacija dve metode, 99mTc-MDP scintigrafije kostiju sa scintigrafijom 99mTc-ciprofloksacinom znatno povećava mogućnost razlikovanja aseptične nestabilnosti i periprotetske infekcije zgloba.

Biografija autora

Dragan Pucar, Military Medical Academy, Institute of Nuclear Medicine, Belgrade, Serbia.

Institut za nuklearnu medicinu VMA

Načelnik Odeljenja za morfološku dijagnostiku

Potpukovnik, prim mr sc med

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Objavljeno
2017/07/07
Broj časopisa
Vol. 74 Br. 7 (2017)
Rubrika
Originalni članak