Can bone scintigraphy predict the final outcome of pasteurized autografts?
Can bone scintigraphy predict the final outcome of pasteurized autografts?
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DOI：
10.1007/s00256-010-0887-3
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发表时间：
2010-10-01
影响因子：
2.1
通讯作者：
Cho, Wan Hyeong
中科院分区：
文献类型：
--
作者：
Eid, Ahmed Shawky;Jeon, Dae-Geun;Cho, Wan Hyeong
随着巴氏消毒法在保肢重建中的应用越来越广泛，需要更多的研究来了解巴氏消毒自体移植物中宿主-移植物连接处的愈合、移植物血管重建和融合以及并发症的发生率和类型。这主要是通过随访X线摄影实现的。我们的目的是澄清是否Tc 99 m骨扫描可以被认为是一个可靠的方法，在确定这三个parameters.27骨肉瘤患者巴氏消毒自体骨移植重建进行了回顾性分析，使用现有的骨显像和放射学随访，术后每6个月为36个月。未愈合病例的随访持续至原始研究期后每个病例可用的最长随访期，范围为1至15个月。Tc ~（99）m吸收分为冷吸收、微弱吸收、中等吸收和高吸收。连接处愈合分为无愈合、部分愈合和完全愈合，70%的连接处愈合，平均愈合时间为22个月。无论最终结果如何，90%至100%的连接在研究的同一时间显示出摄取增加（高或中度）。85%的巴氏灭菌移植物显示出特征性的“电车外观”。4例（15%）移植物并发症：假关节和植入物失效（1例），钢板断裂（1例），髓内钉（IMN）断裂（1例），假体柄在宿主骨内松动（1例），所有病例均存在潜在的连接不愈合。然而，它不能检测或预测连接愈合或并发症的发生。对未愈合的连接处进行补充治疗，显示连接处摄取减少或移植物静止可能是必要的。此外，远处转移和早期局部复发的检测仍然是Tc 99 m扫描在骨肉瘤治疗中的主要应用。
As pasteurization is becoming more widely used in limb salvage reconstruction, more study is required to understand about host-graft junction healing, graft revascularization and incorporation, and the incidence and type of complications among pasteurized autografts. This was mainly achieved by follow-up radiography. We aimed to clarify whether Tc99m bone scanning can be considered a reliable method in determining these three parameters.Twenty-seven osteosarcoma patients with pasteurized autograft reconstructions were retrospectively reviewed using available scintigraphic and radiographic follow-up every 6 months postoperatively for 36 months. Follow-up of the unhealed cases was continued for the maximum follow-up period available for each case beyond the original study period, ranging from 1 to 15 months. Tc99m uptake was classified as cold, faint, moderate and high uptake. Junction healing was classified as none, partial and complete healing.Seventy percent of junctions united with a mean of 22 months. Ninety to 100% of junctions showed increased uptake (high or moderate) at one time of the study regardless of final outcome. 85% of the pasteurized grafts showed the characteristic "tramline appearance". Four grafts (15%) were complicated: pseudoarthrosis and implant failure (1), fractured plate (1), intramedullary nail (IMN) fracture (1), and prosthesis stem loosening in the host bone (1), with underlying unhealed junctions in all cases.Bone scanning can determine the stages of the graft's rim revascularization and incorporation; however, it cannot detect or predict junction healing or occurrence of complications. Supplementary treatment of unhealed junctions showing either decreased junctional uptake or graft quiescence may be warranted. Otherwise, detection of distant metastasis and early local recurrence remains the main application of Tc99m scanning in the management of bone sarcomas.