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ШДЖЭИ Wschodnioeuropejskie Czasopismo Naukowe (East European Scientific Journal) #10, 2016
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DIAGNOSTIC PARAMETERS OF BONE SCINTIGRAPHY FOR KNEE ARTHROPLASTY IN
PATIENTS WITH RHEUMATOID ARTHRITIS
Pavlo Korol,
PhD, assistant professor, A.A. Bohomolets National Medical University, Department of Radiology, Kiev, Ukraine
Michael Tkachenko,
Doctor of Sc., professor, A.A. Bohomolets National Medical University, Department of Radiology, Kiev, Ukraine
The work was defined quantitative parameters of bone scintigraphy in patients with rheumatoid arthritis during knee arthroplasty. Knee arthroplasty without the risk of postoperative complications appropriate to those patients with rheumatoid arthritis, which according of bone scintigraphy percentage accumulation of radiopharmaceuticals in the projection of the affected joint is (+ 10%) - (+ 100%) on the symmetric parts.
Key words: rheumatoid arthritis, bone scintigraphy, knee joint, arthroplasty
Introduction. Rheumatoid arthritis is the most common chronic inflammatory joint disease. The prevalence of the disease among the adult population worldwide is between 0.6 to 5% [3, 345-54; 2]. The disease is most common in people of working age. Peak disease accounts for 40 - 50 years. Thus women suffer in 2 - 4 times more often than men. The incidence of rheumatoid arthritis in women increases after age 30, reaching its highest point at 45 - 75 years. in men, this figure gradually increases and decreases after 70 years [2; 4, 30-31; 10, 1194-96].
with the severity of rheumatoid arthritis joint damage is unmatched among other diseases of the musculoskeletal system. The defeat marked the knee in 65-70% of cases and is the most common cause of disability. Defeat knee joints in rheumatoid arthritis accompanied by the formation and development of serodiscordant contracture deformities of the lower limbs, leading to partial or complete loss of support-locomotors function of the limb. As a result, patients lose their ability to work the possibility of self and become severe disabilities [2; 7, 314-16; 8, 948-49]. So, after three years disease duration losing efficiency up to 50% of patients [3, 345-54; 2; 9, 1836-37].
Studies of domestic and foreign authors indicate that the development of functional significance unfavorable joint deformities surgical care increases. in the later stages of the disease to eliminate multiple deformation and restore musculoskeletal function of joints and limbs in general and, thus, restore the functional activity of the patient and the efficiency is only possible with the help of reconstructive surgery [5, 124950].
Surgical interventions aimed primarily at restoring lost limb function, improve self-improving functional activity of patients.
in recent years, the method of choice in the late stages of rheumatoid arthritis with erosive and destructive lesions of the knee joint arthroplasty [4, 30-31; 1, 21-22]. indications for surgical method of restoring function of the knee joint is pronounced degenerative and destructive changes of the articular surfaces, pain, significant functional impairment due
to contractures, especially with discordant positions extremities [11, 1194-96; 1, 21-22].
Knee arthroplasty is one of the most effective and promising methods restore function of the knee joint in patients with rheumatoid arthritis in the late stages of the disease. Through this method of treatment, patients quickly forget about the pain, restore performance and get back to normal life [5, 1248-49; 10, 332-34].
The aim of this study is the determination of diagnostic parameters of bone scintigraphy during knee arthroplasty in patients with rheumatoid arthritis.
Material and methods. Bone scintigraphy was performed on single head scintillation gamma camera in a static mode in the front line and lateral projections. For the methodology used radiopharmaceutical 99mTc-pyrophosphate, 550-770 MBq activity that administered to the patient intravenously. Static bone scan was performed 3 hours after drug administration. Before the study, patients had to empty the bladder. [6, 345-54]
For a bone scan using multi-channel parallel collimator 140 keV. The optimal number of pulses per frame is 150,000.
Processing of the results of research on the computer includes the steps of contrast, smoothing, highlight areas of interest, followed by histograms [6, 345-47].
results. From 2005 to 2015 by osteostsyntyhrafiyi examined 225 patients with rheumatoid arthritis of the knee (139 women and 86 men) aged 31 to 75 years (average age 49,7 ± 7,8; median 49 years). Knee replacement performed at a late stage disease (stage ii-iii phase ii and phase iii classification of E.T. Sclarenko and V.i. Stetsula, corresponding to the fourth stage of rheumatoid arthritis classification of Shteynbroker).
Bone scintigraphy of knee was performed in the preoperative period (1 week before arthroplasty) to identify quantitative surgical parameters ofbone scintigraphy in patients and 6 months after arthroplasty to monitor the dynamics of pathological process. results of the study were assessed by the nature of the accumulation of radiopharmaceuticals in the pathological focus
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© Pavlo Korol, Michael Tkachenko, 2016
Wschodnioeuropejskie Czasopismo Naukowe (East European Scientific Journal) #10, 2016
UB
and surrounding healthy tissues.
As a result of preoperative diagnostic scan patients were divided into three groups. The first group included 104 (46%) patients in whom the percentage accumulation of radiopharmaceuticals in the projection of the affected joint was equal (+10%) - (+100%), the second - 78 (34%) patients in whom accumulation rate indicator in projection of the affected joint complex was (+101%) - (+180%), the third group consisted of 43 (20%) patients with accumulation indicator in the affected joint projection set over (+180%).
After 6 months after arthroplasty in the quantitative evaluation the bone scan imaging of patients first diagnostic rate of accumulation of radiopharmaceuticals in the projection of paraprosthetic area is equal (+ 5%) - (+ 20%) relative to the symmetric areas of research (Fug. .
Patients of the second diagnostic group arthroplasty rate of accumulation of radiopharmaceuticals in the projection of praprosthetic area is equal (+21%) - (+70%).
a)
Fig. 1 Bone scans imaging of patient with rheumatoid arthritis
In patients of the third group on bone scan imaging the percentage indicator of accumulation in the paraprosthetic area was (+71%) - (+120%).
1 year after knee arthroplasty affected patients first diagnostic of postoperative complications were recorded. In 12 (15%) patients of the second diagnostic group and 15 (34%) patients the three diagnostic group evolved paraprosthetic (implant-associated) infectious complications. Adhesion strains St. epidermidis better held with polymer parts endoprosthesis and strains St. aureus - with metal.
Conclusions. What quantitatively higher percentage inclusion of radiopharmaceuticals in the projection of rheumatoid arthritis affected joint complex at bone scintigraphy in the preoperative period, the higher the likelihood of implant-associated postoperative complications after arthroplasty (p <0,05). Knee arthroplasty without the risk of postoperative complications appropriate to those patients with rheumatoid arthritis, which according of bone scintigraphy percentage accumulation of radiopharmaceuticals in the projection of the affected joint is (+ 10%) - (+ 100%) on the symmetric parts.
*
b)
before (a) and after (b) knee arthroplasty
REFERENCES
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