嬰幼兒骨骺骨髓炎三種不同治療方式對預(yù)后影響的分析研究
發(fā)布時間：2018-07-25 07:45
【摘要】：骨骺骨髓炎是一種骨骺的感染性疾病,而且?guī)缀踔灰娪趮胗變?這是因?yàn)樵邝堪灏l(fā)育成熟之前,骨骺與干骺端之間有血管通道存在,當(dāng)骺板成熟以后則成為阻擋感染擴(kuò)散的防御屏障。該疾病可造成骨骺早閉、骨壞死缺損、關(guān)節(jié)畸形、肢體不等長、患肢功能障礙等不良后果,目前各醫(yī)院對嬰幼兒骨骺骨髓炎的診治經(jīng)驗(yàn)不均衡,手術(shù)方式較為單一,對手術(shù)本身造成的骨骺損傷尚未有明確的認(rèn)識,如果患兒出現(xiàn)骨骺早閉,致殘率極高,因此總結(jié)手術(shù)經(jīng)驗(yàn),對比該手術(shù)方式對預(yù)后的影響,并降低致殘率顯得至關(guān)重要。目前手術(shù)方式多為骨骺及干骺端減張、單純沖洗引流。骨骺及干骺端減張術(shù)是使用電鉆及克氏針對骨骺或干骺端行鉆孔減張,之后在關(guān)節(jié)內(nèi)置入引流管,術(shù)后進(jìn)行持續(xù)的灌洗引流,單純沖洗引流術(shù)中不對骨骺或干骺端進(jìn)行鉆孔減張,通過此課題的研究分析,對在臨床工作中及時明確診斷以及選擇何種手術(shù)方式,有一定的指導(dǎo)意義。目的:分析骨骺骨髓炎的三種不同治療方式,并對患兒進(jìn)行隨訪調(diào)查,分析該治療方式對預(yù)后的影響。方法:選取確診為骨骺骨髓炎的患兒作為研究對象,年齡2月~2歲,病灶部位為肱骨近端骨骺、股骨頭骨骺、股骨遠(yuǎn)端骨骺及脛骨近端骨骺,血常規(guī)顯示白細(xì)胞及血沉、C反應(yīng)蛋白均高于正常值,均有病變部位紅腫、關(guān)節(jié)疼痛、活動受限,X線或MRI檢查均有骨骺區(qū)被破壞,其中行關(guān)節(jié)切開沖洗引流+骨骺及干骺端鉆孔減張術(shù)30例(A組)、行單純關(guān)節(jié)沖洗引流術(shù)30例(B組)、未行手術(shù)治療30例(C組),由于部分病例失隨訪以及數(shù)據(jù)測量不健全,最終每組病例21例,其中各含肩關(guān)節(jié)8例、髖關(guān)節(jié)7例、膝關(guān)節(jié)6例。根據(jù)患兒所行的手術(shù)方式進(jìn)行分組,并選取未行手術(shù)治療的病例入組,進(jìn)行回顧性分析及隨訪,術(shù)后每周復(fù)查血常規(guī)、血沉、C反應(yīng)蛋白連續(xù)復(fù)查3周正常后,改為每個月復(fù)查1次,重點(diǎn)復(fù)查X線及MRI,并對比骨骺有無進(jìn)一步破壞或骨骺生長情況,3個月隨訪患兒肢體長度及關(guān)節(jié)功能恢復(fù)情況,6個月隨訪有無復(fù)發(fā)及肢體畸形的出現(xiàn),通過分析檢查健側(cè)與患側(cè)的肢體長度、關(guān)節(jié)最大活動度(rom)的變化(肩關(guān)節(jié)、髖關(guān)節(jié)、膝關(guān)節(jié))、x線及mri的影像學(xué)變化(破壞范圍、骨質(zhì)密度、周圍軟組織情況),對行不同治療方式的患兒,進(jìn)行對比分析該三種治療方式對預(yù)后的影響。結(jié)果:行關(guān)節(jié)切開沖洗引流+骨骺及干骺端鉆孔減張術(shù)的患兒中,術(shù)后拔除引流管時間7~14天,住院時間14~25天。3個月之后隨診:累及肱骨近端骨骺的8例患兒肩關(guān)節(jié)最大活動度:外展145°~160°,前屈93°~113°、后伸39°~61°;累及股骨頭骨骺的7例患兒髖關(guān)節(jié)最大活動度:屈曲141°~159°,外展71°~84°,內(nèi)收36°~53°;累及脛骨近端的6例患兒膝關(guān)節(jié)最大活動度159°。6個月之后隨診:累及肱骨近端骨骺的8例患兒肩關(guān)節(jié)最大活動度:外展157°~185°,前屈112°~136°、后伸71°~91°;累及股骨頭骨骺的7例患兒髖關(guān)節(jié)最大活動度:屈曲109°~142°,外展75°~89°,內(nèi)收38°~59°;累及脛骨近端的6例患兒膝關(guān)節(jié)最大活動度161°。行關(guān)節(jié)沖洗引流的患兒中,術(shù)后拔除引流管時間15~19天,住院26~34天。3個月之后隨診:累及肱骨近端骨骺的8例患兒肩關(guān)節(jié)最大活動度:外展132°~153°,前屈89°~111°、后伸48°~61°;累及股骨頭骨骺的7例患兒髖關(guān)節(jié)最大活動度:屈曲101°~116°,外展69°~85°,內(nèi)收31°~49°;累及脛骨近端的6例患兒膝關(guān)節(jié)最大活動度149°。6個月之后隨診:累及肱骨近端骨骺的8例患兒肩關(guān)節(jié)最大活動度:外展139°~156°,前屈102°~118°、后伸48°~62°;累及股骨頭骨骺的7例患兒髖關(guān)節(jié)最大活動度:屈曲101°~126°,外展74°~94°,內(nèi)收31°~51°;累及脛骨近端的6例患兒膝關(guān)節(jié)最大活動度153°。未行手術(shù)治療的患兒,住院時間31~40天。3個月之后隨診:累及肱骨近端骨骺的8例患兒肩關(guān)節(jié)最大活動度:外展132°~142°,前屈68°~91°、后伸46°~52°;累及股骨頭骨骺的7例患兒髖關(guān)節(jié)最大活動度:屈曲67°~83°,外展67°~70°,內(nèi)收28°~32°;累及脛骨近端的6例患兒膝關(guān)節(jié)最大活動度143°。6個月之后隨診:累及肱骨近端骨骺的8例患兒肩關(guān)節(jié)最大活動度:外展134°~156°,前屈81°~91°、后伸47°~56°;累及股骨頭骨骺的7例患兒髖關(guān)節(jié)最大活動度:屈曲76°~92°,外展60°~76°,內(nèi)收33°~42°;累及脛骨近端的6例患兒膝關(guān)節(jié)最大活動度148°。行關(guān)節(jié)切開沖洗引流+骨骺及干骺端鉆孔減張術(shù)可以有效的減輕干骺端張力、充分的引流、刺激干骺端血運(yùn)恢復(fù),患兒住院時間及術(shù)后拔管時間明顯縮短,術(shù)后長期隨診差異性顯著,肩關(guān)節(jié)、髖關(guān)節(jié)及膝關(guān)節(jié)功能恢復(fù)的程度好于單純行切開引流術(shù)的患兒和未行手術(shù)治療的患兒。結(jié)論:對于行切開引流+干骺端鉆孔減張術(shù)的患兒引流管拔除時間以及平均住院時間均有所縮短,可以有效的減少患兒家庭的經(jīng)濟(jì)負(fù)擔(dān),增加病房床位周轉(zhuǎn)率;對于術(shù)后3個月之后以及6個月之后的隨訪結(jié)果,行切開引流+干骺端鉆孔減張術(shù)的患兒各關(guān)節(jié)功能活動范圍的恢復(fù)以及影像學(xué)表現(xiàn)的恢復(fù)情況均好于單純行切開引流術(shù)的患兒和未行手術(shù)治療的患兒,可以降低該疾病的致殘率,提高患兒術(shù)后生活質(zhì)量。
[Abstract]:Epiphyseal osteomyelitis is an infectious disease of the epiphysis and almost only in infants. This is because there is a vascular channel between the epiphysis and metaphysis before the epiphyseal matures. When the epiphyseal plate is mature, it becomes a defensive barrier to prevent the spread of infection. The experience of the diagnosis and treatment of the epiphyseal osteomyelitis in all hospitals is not balanced, the operation mode is relatively simple, and the epiphyseal damage caused by the operation is not clear. If the epiphysis is closed and the rate of disability is very high, the surgical experience is summed up and the prognosis is compared. It is very important to influence and reduce the rate of disability. At present, the surgical methods are epiphysis and epiphyseal reduction, simple irrigation and drainage. Epiphyseal and epiphyseal decompression is the use of electric drill and Kirschner's epiphysis or epiphysis to reduce the tension, then the drainage tube is inserted into the joint in the joint. To reduce the tension of the epiphysis or epiphysis, through the research and analysis of this topic, it has a certain guiding significance for the timely and clear diagnosis and selection of the mode of operation in clinical work. Objective: to analyze three different treatments of osteomyelitis of epiphysis and to investigate the effect of the treatment on the prognosis. The children who were diagnosed as epiphysis osteomyelitis were selected as the study object. The age was ~2 years old in February. The location of the lesion was proximal epiphysis of the humerus, the epiphysis of the femoral head, the epiphysis of the distal femur and the epiphysis of the tibia. The blood routine showed leukocyte and erythrocyte sedimentation, and the C reaction protein was higher than the normal value. There were red and swelling of the lesion, joint pain, limited activity, X-ray or MRI examination. The epiphyseal area was destroyed, of which 30 cases (group A) were performed joint incision, drainage, epiphysis and epiphyseal reduction, 30 cases (group B) with simple joint irrigation and drainage (group B), 30 cases (group C) without surgical treatment (group C). Due to some cases of lost follow-up and unsound data measurement, there were 8 cases of shoulder joints, 7 cases of hip joint, and knee joint. 6 cases of joint were divided into groups according to the operation mode of the children, and the cases in which the patients were not treated were selected for retrospective analysis and follow-up. After the reexamination of blood routine, erythrocyte sedimentation rate, C reactivity protein for 3 weeks after the operation, 1 times a month was rechecked, and the X-ray and the epiphysis were further examined and compared with the epiphysis to further damage or epiphysis. The length of limb and the recovery of joint function of the children were followed up for 3 months. There were no recurrence and limb deformity in 6 months. The changes of ROM (shoulder joint, hip joint, knee joint), X-ray and MRI (destruction range, bone density, surrounding) were examined by analysis of the limb length of the side and the affected side. The effects of the three treatments on the prognosis were compared and analyzed in children with different treatments. Results: in children with joint incision, drainage, epiphysis and epiphyseal reduction, the time of removal of drainage tube was 7~14 days after operation, and 8 cases involving the proximal epiphysis of the humerus were followed up to 8 cases after.3 months of hospitalization. The maximum activity of shoulder joint in children: abduction 145 ~160 degrees, flexion 93 ~113 degrees, and extension 39 degree ~61 degrees; the maximum hip joint activity of 7 cases involving the epiphysis of the femoral head: flexion 141 degree ~159 degrees, abduction 71 ~84 degrees, 36 degree ~53 degrees, and the follow-up of the maximum knee joint activity of the proximal tibia for 159 degree.6 months after: the proximal epiphysis involving the humerus The maximum activity of shoulder joint in 8 children: abduction 157 ~185 degrees, anterior flexion 112 ~136 degrees, and extension 71 degree ~91 degrees; the maximum hip joint activity of 7 cases involving the epiphysis of the femoral head: flexion 109 degree ~142 degrees, abduction 75 [~89], 38 degree ~59 degrees, and 161 degrees of the knee joint in 6 cases involving the proximal tibia. Extraction of drainage tube time 15~19 days, 26~34 days after.3 months of hospitalization, after.3 months of hospitalization: the maximum activity of the shoulder joint involving the proximal epiphysis of the humerus: the abduction of 132 degree ~153 degrees, the flexion 89 [89] ~111, and the extension 48 degrees ~61 degrees; the maximum hip joint activity of 7 cases involving the epiphysis of the femoral head: flexor 101 [degree], 69 degree ~85 DEG, and 31 degree degrees; tiring tibial tibial The maximum activity of the knee joint in 6 cases of the proximal end was followed by 149.6 months. The maximum activity of the shoulder joint in 8 cases involving the proximal epiphysis of the humerus: abduction 139 [139], 102 degrees ~118 degrees, and 48 degree ~62 degrees; 7 children involved in the epiphysis of the femoral head: flexion 101 [~126], abduction 74 [~94], and 31 [degree]; involvement of 31 [degree]; involvement of 31 [degree]; involvement of 31 degrees. The maximum activity of the knee joint was 153 degrees in 6 cases of proximal tibial. The hospitalization time was 31~40 days.3 months later: the maximum activity of the shoulder joint in 8 cases involving the proximal epiphysis of the humerus: abduction 132 [~142], 68 degrees ~91 degrees, and 7 cases of femoral head epiphysis: the maximum hip joint activity: flexion 67 degree ~83 degrees, abduction 67 ~70 degrees, 28 degree ~32 degrees; the maximum activity of knee joint in 6 cases involving the proximal tibia was followed by 143 degree.6 months. The maximum activity of shoulder joint in 8 cases involving the proximal epiphysis of the humerus: the abduction 134 [~156], the anterior flexion 81 degree, and the 47 degree ~56 degrees; the maximum hip joint activity of 7 cases involving the epiphysis of the femoral head: Flexion 76 ~92 degrees, abduction 60 ~76 degrees, 33 degree ~42 degrees, and the maximum knee joint activity of 6 cases involving the proximal tibia of 148 degrees. Joint incision and drainage, epiphysis and epiphyseal reduction can effectively reduce the epiphyseal tension, full drainage, stimulate the recovery of the metaphysis blood, the time of hospitalization and postoperative extubation time of the children are obviously shrinking. Short, significant difference in postoperative long-term follow-up, shoulder joint, hip and knee joint function recovery is better than that of children with simple incision and drainage and children who are not operated on. Conclusion: the removal of drainage tube time and average length of hospitalization in children with incision and metaphyseal drilling reduction can be effectively reduced. The economic burden of the family was reduced and the bed turnover rate was increased; for 3 months after the operation and the follow-up of 6 months after the operation, the recovery of the range of functional activities of the joints and the recovery of the imaging manifestations were better than those of the children who were treated with simple incision and drainage. Surgical treatment of children can reduce the disability rate of the disease and improve the quality of life of children.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R726.8
本文編號：2143121
[Abstract]:Epiphyseal osteomyelitis is an infectious disease of the epiphysis and almost only in infants. This is because there is a vascular channel between the epiphysis and metaphysis before the epiphyseal matures. When the epiphyseal plate is mature, it becomes a defensive barrier to prevent the spread of infection. The experience of the diagnosis and treatment of the epiphyseal osteomyelitis in all hospitals is not balanced, the operation mode is relatively simple, and the epiphyseal damage caused by the operation is not clear. If the epiphysis is closed and the rate of disability is very high, the surgical experience is summed up and the prognosis is compared. It is very important to influence and reduce the rate of disability. At present, the surgical methods are epiphysis and epiphyseal reduction, simple irrigation and drainage. Epiphyseal and epiphyseal decompression is the use of electric drill and Kirschner's epiphysis or epiphysis to reduce the tension, then the drainage tube is inserted into the joint in the joint. To reduce the tension of the epiphysis or epiphysis, through the research and analysis of this topic, it has a certain guiding significance for the timely and clear diagnosis and selection of the mode of operation in clinical work. Objective: to analyze three different treatments of osteomyelitis of epiphysis and to investigate the effect of the treatment on the prognosis. The children who were diagnosed as epiphysis osteomyelitis were selected as the study object. The age was ~2 years old in February. The location of the lesion was proximal epiphysis of the humerus, the epiphysis of the femoral head, the epiphysis of the distal femur and the epiphysis of the tibia. The blood routine showed leukocyte and erythrocyte sedimentation, and the C reaction protein was higher than the normal value. There were red and swelling of the lesion, joint pain, limited activity, X-ray or MRI examination. The epiphyseal area was destroyed, of which 30 cases (group A) were performed joint incision, drainage, epiphysis and epiphyseal reduction, 30 cases (group B) with simple joint irrigation and drainage (group B), 30 cases (group C) without surgical treatment (group C). Due to some cases of lost follow-up and unsound data measurement, there were 8 cases of shoulder joints, 7 cases of hip joint, and knee joint. 6 cases of joint were divided into groups according to the operation mode of the children, and the cases in which the patients were not treated were selected for retrospective analysis and follow-up. After the reexamination of blood routine, erythrocyte sedimentation rate, C reactivity protein for 3 weeks after the operation, 1 times a month was rechecked, and the X-ray and the epiphysis were further examined and compared with the epiphysis to further damage or epiphysis. The length of limb and the recovery of joint function of the children were followed up for 3 months. There were no recurrence and limb deformity in 6 months. The changes of ROM (shoulder joint, hip joint, knee joint), X-ray and MRI (destruction range, bone density, surrounding) were examined by analysis of the limb length of the side and the affected side. The effects of the three treatments on the prognosis were compared and analyzed in children with different treatments. Results: in children with joint incision, drainage, epiphysis and epiphyseal reduction, the time of removal of drainage tube was 7~14 days after operation, and 8 cases involving the proximal epiphysis of the humerus were followed up to 8 cases after.3 months of hospitalization. The maximum activity of shoulder joint in children: abduction 145 ~160 degrees, flexion 93 ~113 degrees, and extension 39 degree ~61 degrees; the maximum hip joint activity of 7 cases involving the epiphysis of the femoral head: flexion 141 degree ~159 degrees, abduction 71 ~84 degrees, 36 degree ~53 degrees, and the follow-up of the maximum knee joint activity of the proximal tibia for 159 degree.6 months after: the proximal epiphysis involving the humerus The maximum activity of shoulder joint in 8 children: abduction 157 ~185 degrees, anterior flexion 112 ~136 degrees, and extension 71 degree ~91 degrees; the maximum hip joint activity of 7 cases involving the epiphysis of the femoral head: flexion 109 degree ~142 degrees, abduction 75 [~89], 38 degree ~59 degrees, and 161 degrees of the knee joint in 6 cases involving the proximal tibia. Extraction of drainage tube time 15~19 days, 26~34 days after.3 months of hospitalization, after.3 months of hospitalization: the maximum activity of the shoulder joint involving the proximal epiphysis of the humerus: the abduction of 132 degree ~153 degrees, the flexion 89 [89] ~111, and the extension 48 degrees ~61 degrees; the maximum hip joint activity of 7 cases involving the epiphysis of the femoral head: flexor 101 [degree], 69 degree ~85 DEG, and 31 degree degrees; tiring tibial tibial The maximum activity of the knee joint in 6 cases of the proximal end was followed by 149.6 months. The maximum activity of the shoulder joint in 8 cases involving the proximal epiphysis of the humerus: abduction 139 [139], 102 degrees ~118 degrees, and 48 degree ~62 degrees; 7 children involved in the epiphysis of the femoral head: flexion 101 [~126], abduction 74 [~94], and 31 [degree]; involvement of 31 [degree]; involvement of 31 [degree]; involvement of 31 degrees. The maximum activity of the knee joint was 153 degrees in 6 cases of proximal tibial. The hospitalization time was 31~40 days.3 months later: the maximum activity of the shoulder joint in 8 cases involving the proximal epiphysis of the humerus: abduction 132 [~142], 68 degrees ~91 degrees, and 7 cases of femoral head epiphysis: the maximum hip joint activity: flexion 67 degree ~83 degrees, abduction 67 ~70 degrees, 28 degree ~32 degrees; the maximum activity of knee joint in 6 cases involving the proximal tibia was followed by 143 degree.6 months. The maximum activity of shoulder joint in 8 cases involving the proximal epiphysis of the humerus: the abduction 134 [~156], the anterior flexion 81 degree, and the 47 degree ~56 degrees; the maximum hip joint activity of 7 cases involving the epiphysis of the femoral head: Flexion 76 ~92 degrees, abduction 60 ~76 degrees, 33 degree ~42 degrees, and the maximum knee joint activity of 6 cases involving the proximal tibia of 148 degrees. Joint incision and drainage, epiphysis and epiphyseal reduction can effectively reduce the epiphyseal tension, full drainage, stimulate the recovery of the metaphysis blood, the time of hospitalization and postoperative extubation time of the children are obviously shrinking. Short, significant difference in postoperative long-term follow-up, shoulder joint, hip and knee joint function recovery is better than that of children with simple incision and drainage and children who are not operated on. Conclusion: the removal of drainage tube time and average length of hospitalization in children with incision and metaphyseal drilling reduction can be effectively reduced. The economic burden of the family was reduced and the bed turnover rate was increased; for 3 months after the operation and the follow-up of 6 months after the operation, the recovery of the range of functional activities of the joints and the recovery of the imaging manifestations were better than those of the children who were treated with simple incision and drainage. Surgical treatment of children can reduce the disability rate of the disease and improve the quality of life of children.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R726.8
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