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目的:介绍放射性核素、载体的选择以及放射性滑膜切除术的适应证、禁忌证、并发症以及临床应用中的注意事项,为放射性滑膜切除术的临床应用提供一定的参考。资料来源:应用医学文献王软件在PubMed上检索所有字段中包含“radiation suynovectomy”或“radiosynovectomy”的文章,不设置其他限制,检索到277篇文章题录。资料选择:对检索到的文章进行初审。通过阅读所有文章的文题和大部分文章的摘要,选择内容与放射性核素、载体和滑膜切除密切相关的文章,在相关数据库上查找全文。主要以Science Direct和OVID两个数据库为主。资料提炼:经过初审得到58篇文章,排除重复性研究,同一领域的文章选择近期发表或权威杂志的文章。共41篇文章纳入分析。资料综合:放射性核素目前研究的热点:一是载体的选择,硅酸盐、枸橼酸盐、草酸盐、大颗粒氢氧化铁、羟磷灰石、聚乳酸、硫胶体、中心体等广泛被用作载体。良好的载体能够控制放射性药物的剂量和稳定性,减少核素从关节中的泄漏。二是包含核素和载体的放射性药物。理想的用于放射性滑膜切除术的药物应具备以下条件:①核素较小可以被细胞吞噬。但也不能太小,否则在被吞噬之前易从关节中泄漏。通常认为核素合适的大小应该是2～10μm。②在放射治疗的全程中放射性核素和载体的结合是不可逆的,这种结合由放射性核素的物理半衰期决定。③放射性标记的颗粒应该能够均匀分布于关节中,并且不促使炎症的发生。④载体的半衰期应长于所结合的核素的半衰期。载体应可以生物降解,以便在治疗后能够被机体清除。⑤稳定性好,成本低也是其重要特性。三是许多临床实验均已证明放射性化膜切除术是治疗多种慢性关节炎的有效方法。结论:正确选择放射性药物、合理选择适应证、规范操作,放射性滑膜切除术是类风湿性关节炎,血友病性关节炎,绒毛结节性色素滑膜炎等多种关节疾病安全、低成本的有效治疗方法。
OBJECTIVE: To introduce the selection of radionuclides, radiological synovial synovial sutures and their indications, contraindications, complications and precautions in clinical application, so as to provide some references for the clinical application of radiosynovyctomy. Source: Applied Medical Literature Wang software searches PubMed for articles that contain “radiation suynovectomy” or “radiosynovectomy” in all fields, and 277 articles were retrieved without setting additional restrictions. Data Selection: The first article to retrieve the article. Find the full article on the relevant database by reading the essays in all articles and a summary of the majority of articles, and selecting articles closely related to radionuclides, vectors and synovial resections. Mainly to Science Direct and OVID two databases. Data Extraction: After the first instance 58 articles were obtained, excluding repetitive studies, articles in the same field were selected recently published articles or authoritative articles. A total of 41 articles included in the analysis. DATA SYNTHESIS: Radionuclides Currently the hotspot of research: First, the choice of carrier, silicate, citrate, oxalate, large iron hydroxide, hydroxyapatite, polylactic acid, sulfur colloids, centrosomes, etc. Widely used as a carrier. A good carrier controls the dose and stability of radiopharmaceuticals and reduces nuclide leakage from the joints. The second is a radionuclide that contains a nuclide and a carrier. Ideal for radioactive synovectomy drugs should have the following conditions: ① small nuclides can be phagocytosed by the cells. But it can not be too small, otherwise it is easy to leak from the joint before it is swallowed. It is generally accepted that the appropriate size of the nuclide should be 2 to 10 μm. ② The combination of radionuclide and carrier throughout the course of radiation therapy is irreversible and this combination is dictated by the physical half-life of the radionuclide. ③ radioactive labeled particles should be able to evenly distributed in the joints, and does not promote the occurrence of inflammation. The half-life of the carrier should be longer than the half-life of the bound nuclide. The carrier should be biodegradable so that it can be cleared by the body after treatment. ⑤ good stability, low cost is also an important feature. Third, many clinical trials have proved that radiofrequency excision is an effective method for the treatment of a variety of chronic arthritis. Conclusion: The correct choice of radiopharmaceuticals, the rational choice of indications, standardized operation, radiosynoviactomy is rheumatoid arthritis, hemophilic arthritis, villonodular synovitis and other joint diseases, safe, low Cost effective treatment.