Die klinische Relevanz der Ganzkörperskelettszintigraphie bei mehrfachverletzten und polytraumatisierten Patienten

Abstract

The provision of care to polytraumatised patients is a particular diagnostic and therapeutic challenge. The examination data of 162 polytraumatised patients were retrospectively investigated to determine the diagnostic gain provided by skeletal scintigraphy with 99mTc-HMDP. It was found that every fresh fracture (with the exception of fractures to the skull) led to a scintigraphically clearly demonstrable remodelling reaction within ten to 14 days. The timing of the examination was of decisive importance for the information yield. Not until about the tenth to 12th day did also those fractures that showed a delayed uptake show adequately signal-intensive areas of uptake in the scintigram. Typical examples were additional fractures of the spine and pelvis in patients immobilised by fractures of the limbs. At this time, with the aim of skeletal scintigraphy, an additional fracture was found in half of all patients, and was subsequently verified radiologically. Additional diagnostic information is independent of the ability of the patient to cooperate. This was of particular importance in the case of the very severely injured and old patients. Skeletal scintigraphy can be employed with equal efficacy to reliably exclude bone injuries. Thus, skeletal scintigraphy if of particular significance in the determination of the extent of bone injury in polytraumatised patients. This applies in particular to the preparation of an expertise. Thus, as in the case of staging of malignomas, the additional performance of bone scanning twelve to 14 days after traumatisation should form part of routine care offered to polytraumatised patients.

Aktuelles diagnostisches Vorgehen bei Verletzungen der Brust- und Lendenwirbelsäule

“…Funktionsaufnahmen sollten nur unter ärztlicher Kontrolle -am besten vom Wirbelsäulenchirurgen selbst -durchgeführt werden. In besonderen Fällen kann beim polytraumatisierten Patienten zum so genannten "Frakturscreening" eine Skelettszintigraphie veranlasst werden [12]. Diese ist jedoch erst nach dem 8. posttraumatischen Tag aussagekräftig [5].…”

“…Zum Nachweis von verborgenen Frakturen im Sinn eines so genannten "Frakturscreenings" wurde von Spitz et al [12] die Durchführung einer Skelettszintigraphie empfohlen. Der beste Zeitpunkt ist 12-14 Tage nach der Verletzung.…”