The Value Of SPECT/CT In Evaluating The Range Of Osteotomy In The Treatment Of Chronic Osteomyelitis With Ilizarov Technique

Objective:To evaluate the surgical osteotomy of SPECT/CT in the treatment of chronic osteomyelitis with Ilizarov technique.Methods:The clinical and image data of 24 patients with fracture-related infection and chronic osteomyelitis treated with the Ilizarov technique were retrospectively analyzed,including 21males and 3 females,aged 16-68 years.All patients received preoperative check through^99mTc-MDP SPECT/CT,and the results were analyzed by a senior nuclear medicine physician to obtain a diagnostic opinion that measured the range of abnormal concentration areas shown on the SPECT/CT images.All patients received foci bone removal surgery antibiotic bone cement placement,and ring external fixator placement.The surgeon determined the resection range of the focal bone segment by referring to the range of abnormal concentration and combining with the intraoperative findings,and sent the intraoperative resection of the focal bone segment to pathological examination.The diagnosis was confirmed by pathological examination,and the presence of inflammatory cell infiltration on both incisional margins was observed.The pathologic results were compared with the range of abnormal concentration on preoperative SPECT/CT images to evaluate the accuracy of diagnostic results and specific surgery operation on the resection range of the infected bone segment.Results:Among the 24 patients,21 of them were pathologically diagnosed as osteomyelitis,2were infectious bone nonunion,and 1 was fracture nonunion.There were 20 patients diagnosed as osteomyelitis by preoperative three-phase bone image combined with SPECT/CT fusion images,and 4 patients were diagnosed as fracture nonunion.Among the patients diagnosed as osteomyelitis,1 of them was pathologically diagnosed as fracture nonunion after surgery.Among the patients diagnosed as fracture nonunion,2 of them were pathologically diagnosed as osteomyelitis after surgery,and 1 was pathologically diagnosed as fracture nonunion due to the positive result of bacterial culture on the wound surface during operation.The sensitivity,specificity and accuracy of SPECT/CT diagnosis were 90.5%（19/21）,66.7%（2/3）and 87.5%（21/24）.Among the patients diagnosed with osteomyelitis,6 patients had no inflammatory cell infiltration on both sides of the surgical margin,3patients had inflammatory cell infiltration on one side of the surgical margin,and 12 patients had inflammatory cell infiltration on both sides of the surgical margin.Of the 21 patients diagnosed with osteomyelitis,the range of infected bone segment obtained by preoperative SPECT/CT fusion image was consistent with the actual range of intraoperative osteotomy in15 cases.Conclusion:SPECT/CT is an accurate diagnostic method for chronic osteomyelitis and has an advantage in the diagnosis of patients with metal implants.It can locate the infected lesions before surgery and evaluate the scope of the lesions.It is of great significance in guiding the surgical removal of the lesions,reducing the damage to the patients and shortening the treatment period.