【摘要】 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。更多还原

【Abstract】 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=A) 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 definite 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 fixed 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 fixator in 1 patient,and it disappeared after the fixator was removed.The union of the planted bone was achieved at an average period of 7 months after the operation(range:5-9months),with the recanalization of the medullary cavity.No recurrence of bone infarction was found in the followup period.Conclusions The clinical symptoms of bone infarction are often atypical,and no specific signs exist in the early stage based on the X-ray examination.Therefore,it is difficult to make a definite 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.更多还原