中国骨与关节杂志
中國骨與關節雜誌
중국골여관절잡지
Chinese Journal of Bone and Joint
2014年
6期
470-473
,共4页
张耀%赵德伟%王卫明%刘宇鹏%于晓兵
張耀%趙德偉%王衛明%劉宇鵬%于曉兵
장요%조덕위%왕위명%류우붕%우효병
骨梗死%骨坏死%诊断%治疗%影像学
骨梗死%骨壞死%診斷%治療%影像學
골경사%골배사%진단%치료%영상학
Bone infarction%Osteonecrosis%Diagnosis%Treatment%Imaging
目的：探讨长骨骨梗死的诊断、手术治疗效果及对该病的认识体会。方法自2009年9月至2012年8月，手术治疗长骨骨梗死患者15例。男9例，女6例，平均年龄46(23～58)岁。病灶部位：肱骨近端1例，股骨近端2例，股骨远端7例(双侧4例)，胫骨近端4例(双侧2例)，股骨远端及胫骨近端同时受累1例。致病因素：特发或不明原因5例，使用激素3例，有外伤史3例，酗酒2例，潜水病2例。所有患者经术前临床、影像学检查及穿刺活检或手术病理检查证实诊断。手术治疗方式为于病变骨段局部开窗，将病灶及硬化带完全清除、打通髓腔，骨缺损区用自体骨加异体骨填塞夯实，然后上锁定钛板跨越病灶区固定，以增加力学强度。患者术后每4周回院进行1次临床和X线检查，自患肢可以完全负重起每2～3个月复查1次。术后随访患者缓解情况，X线观察植骨区骨质愈合情况及随访观察有无骨梗死复发。结果本组所有患者均获得随访。平均随访时间为23(14～37)个月。其中14例术后疼痛、不适症状均缓解，肢体功能良好。1例术后内固定物处偶发疼痛，内固定物去除后疼痛消失。术后5～9(平均7)个月植骨区骨质愈合，髓腔再通。随访期内所有患者无骨梗死复发。结论骨梗死症状常不典型，早期X线检查基本无特异征象，不易明确诊断。MRI 检查则有助于提高诊断的准确率。对疼痛明显，存在骨折或关节面塌陷风险的骨梗死患者进行手术治疗，能够取得满意的治疗效果。
目的：探討長骨骨梗死的診斷、手術治療效果及對該病的認識體會。方法自2009年9月至2012年8月，手術治療長骨骨梗死患者15例。男9例，女6例，平均年齡46(23～58)歲。病竈部位：肱骨近耑1例，股骨近耑2例，股骨遠耑7例(雙側4例)，脛骨近耑4例(雙側2例)，股骨遠耑及脛骨近耑同時受纍1例。緻病因素：特髮或不明原因5例，使用激素3例，有外傷史3例，酗酒2例，潛水病2例。所有患者經術前臨床、影像學檢查及穿刺活檢或手術病理檢查證實診斷。手術治療方式為于病變骨段跼部開窗，將病竈及硬化帶完全清除、打通髓腔，骨缺損區用自體骨加異體骨填塞夯實，然後上鎖定鈦闆跨越病竈區固定，以增加力學彊度。患者術後每4週迴院進行1次臨床和X線檢查，自患肢可以完全負重起每2～3箇月複查1次。術後隨訪患者緩解情況，X線觀察植骨區骨質愈閤情況及隨訪觀察有無骨梗死複髮。結果本組所有患者均穫得隨訪。平均隨訪時間為23(14～37)箇月。其中14例術後疼痛、不適癥狀均緩解，肢體功能良好。1例術後內固定物處偶髮疼痛，內固定物去除後疼痛消失。術後5～9(平均7)箇月植骨區骨質愈閤，髓腔再通。隨訪期內所有患者無骨梗死複髮。結論骨梗死癥狀常不典型，早期X線檢查基本無特異徵象，不易明確診斷。MRI 檢查則有助于提高診斷的準確率。對疼痛明顯，存在骨摺或關節麵塌陷風險的骨梗死患者進行手術治療，能夠取得滿意的治療效果。
목적：탐토장골골경사적진단、수술치료효과급대해병적인식체회。방법자2009년9월지2012년8월，수술치료장골골경사환자15례。남9례，녀6례，평균년령46(23～58)세。병조부위：굉골근단1례，고골근단2례，고골원단7례(쌍측4례)，경골근단4례(쌍측2례)，고골원단급경골근단동시수루1례。치병인소：특발혹불명원인5례，사용격소3례，유외상사3례，후주2례，잠수병2례。소유환자경술전림상、영상학검사급천자활검혹수술병리검사증실진단。수술치료방식위우병변골단국부개창，장병조급경화대완전청제、타통수강，골결손구용자체골가이체골전새항실，연후상쇄정태판과월병조구고정，이증가역학강도。환자술후매4주회원진행1차림상화X선검사，자환지가이완전부중기매2～3개월복사1차。술후수방환자완해정황，X선관찰식골구골질유합정황급수방관찰유무골경사복발。결과본조소유환자균획득수방。평균수방시간위23(14～37)개월。기중14례술후동통、불괄증상균완해，지체공능량호。1례술후내고정물처우발동통，내고정물거제후동통소실。술후5～9(평균7)개월식골구골질유합，수강재통。수방기내소유환자무골경사복발。결론골경사증상상불전형，조기X선검사기본무특이정상，불역명학진단。MRI 검사칙유조우제고진단적준학솔。대동통명현，존재골절혹관절면탑함풍험적골경사환자진행수술치료，능구취득만의적치료효과。
Objective To investigate the diagnosis and operative treatment results of long bone infarction and the understanding of this disease.Methods From September 2009 to August 2012, 15 patients underwent operative treatment for the long bone infarction. There were 9 males and 6 females, whose average age was 46 years old ( range: 23-58 years ). The lesions were located in the proximal humerus (n=1 ), the proximal femur (n=2 ), the distal femur (n=7 ), the proximal tibia (n=4 ) and the distal femur together with the proximal tibia (n=1 ). Bilateral bone infarction was noticed in the distal femur (n=4 ) and in the proximal tibia (n=2 ). The etiology of bone infarction was idiopathic or unknown in 5 cases, which was caused by corticosteroids in 3 cases, a traumatic event in 3 cases, alcohol abuse in 2 cases and caisson disease in 2 cases. The deifnite diagnosis was determined before the operation through the clinical and imaging examinations and aspiration biopsy or pathological examination. The surgical fenestration of bone segments was performed locally. The lesions and sclerotic region were completely resected, and the blocked medullary cavity was broken through. The defects were packed fully with autogenous bone and allogeneic bone grafts. The locking titanium plate was then ifxed crossing the lesion area in order to increase the mechanical strength of the bone. All the patients underwent the clinical and radiographic examinations at every 4 weeks postoperatively, and they were reviewed since full weight bearing on the affected limbs at 2 to 3 months intervals thereafter. The changes of symptoms and the recurrence of bone infarction were observed, and the union of the planted bone was checked based on the X-ray in the follow-up.Results All the patients were followed up for an average period of 23 months ( range: 14-37 months ). The postoperative pain and uncomfortable symptoms were alleviated in 14 patients, whose limb functions were also restored. Mild pain would occur occasionally at the internal ifxator in 1 patient, and it disappeared after the ifxator was removed. The union of the planted bone was achieved at an average period of 7 months after the operation ( range: 5-9 months ), with the recanalization of the medullary cavity. No recurrence of bone infarction was found in the follow-up period.Conclusions The clinical symptoms of bone infarction are often atypical, and no speciifc signs exist in the early stage based on the X-ray examination. Therefore, it is dififcult to make a deifnite diagnosis. The MRI examination can help improve the diagnostic accuracy. Operative treatment is needed for the patients with bone infarction because of the severe pain or the risk of fractures or articular surface collapse, and satisfactory therapeutic effects can be achieved.
