本文選題：牽拉成骨　切入點(diǎn)：骨延長　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本實(shí)驗(yàn)通過分別用X線與超聲技術(shù)監(jiān)測骨延長過程中各個時間點(diǎn)病人骨痂形成及周圍血供的情況,通過與傳統(tǒng)監(jiān)測手段X線的對比,找出超聲在骨延長過程中的監(jiān)測價值。方法:選取10例需要骨搬移或骨延長的病人做為實(shí)驗(yàn)對象。應(yīng)用超聲、X線分別在截骨前、截骨后、骨延長階段、骨礦化階段對病人進(jìn)行檢查。骨搬移前期階段檢查間隔時間為2周,后期可根據(jù)情況調(diào)整間隔時間。對比超聲和X線所監(jiān)測得到骨痂和血供的信息,得出各自的優(yōu)缺點(diǎn),并通過對結(jié)果的分析對病人采取相應(yīng)的措施。結(jié)果:X線本身是一種放射性檢查,對患者有一定損害。它可以確定患者術(shù)后截骨是否完全離斷,通過X線可以準(zhǔn)確測量延長間隙的牽拉長度,觀察肢體力線,觀察骨延長過程中是否存在截骨端延時愈合、不愈合、過早愈合、臨近關(guān)節(jié)是否存在畸形、脫位等情況,骨延長后期階段X線可以顯示延長區(qū)域骨皮質(zhì)和骨髓腔的形成情況,結(jié)合臨床表現(xiàn)指導(dǎo)去除外固定架的時間。但是普通X線不能評價骨延長早期新生骨痂的情況,所以對于早期指導(dǎo)牽拉成骨的速度調(diào)節(jié)存在一定的局限性。X線無法觀察到延長區(qū)域血流信號情況,并且對于血管神經(jīng)牽拉傷,延長區(qū)出現(xiàn)囊泡等并發(fā)癥也無法監(jiān)測。同時X線只能對延長區(qū)骨痂進(jìn)行定性的描述而無法定量的檢測。超聲監(jiān)測骨延長過程具有他自身的優(yōu)勢,尤其是在牽拉延長早期的延長區(qū)域的血腫機(jī)化期,X線無法顯像,而超聲能明顯的觀察到。超聲能更早的監(jiān)測到新生骨痂并評價骨痂的多少,這就使得醫(yī)務(wù)工作者可以更早的根據(jù)監(jiān)測結(jié)果調(diào)整牽拉延長的速度以避免如延時愈合、過早愈合等并發(fā)癥的發(fā)生。對于其他并發(fā)癥如延長區(qū)域出現(xiàn)液性囊泡等超聲也可以及時發(fā)現(xiàn)。另外超聲可以監(jiān)測到延長區(qū)域周圍血供的情況,從而預(yù)測骨痂的形成情況。同時超聲還具有方便攜帶、無創(chuàng)、檢查快捷方便、費(fèi)用低廉、無輻射、易接受等優(yōu)點(diǎn)。但是超聲對于牽拉延長晚期骨礦化階段的監(jiān)測有一定的局限性使其無法指導(dǎo)拆除外固定架時間。同時超聲顯像對于肢體力線表現(xiàn)不夠直觀,且無法測量后期截骨端間隙。超聲對于骨痂的定量監(jiān)測也有一定的局限性。結(jié)論:X線與超聲各自有各自的優(yōu)缺點(diǎn)。在監(jiān)測整個骨延長過程中彼此不可替代、互相補(bǔ)充。如果將這兩種監(jiān)測手段聯(lián)合應(yīng)用于監(jiān)測骨延長的過程中,則會更加優(yōu)化骨延長的評價標(biāo)準(zhǔn)。
[Abstract]:Objective: to monitor callus formation and blood supply of patients at different time points during bone lengthening by X-ray and ultrasound respectively. To find out the monitoring value of ultrasound in the process of bone lengthening. Methods: ten patients who needed bone removal or bone lengthening were selected as experimental subjects. The patients were examined in the bone mineralization stage. The interval was 2 weeks in the early stage of bone transfer, and the interval time could be adjusted according to the situation at the later stage. Compared with the information of callus and blood supply monitored by ultrasound and X-ray, the advantages and disadvantages of each of them were obtained. And through the analysis of the results, the corresponding measures were taken for the patients. Results the W: X ray itself is a kind of radioactivity examination, which is harmful to the patients. It can determine whether the osteotomy of the patients is complete after operation. X-ray can accurately measure the stretch length of the extended gap, observe the limb force line, observe whether there is delayed healing, nonunion, premature healing, deformity and dislocation of the adjacent joints during bone lengthening. X ray can show the formation of cortical bone and medullary cavity in the lengthened area during the late stage of bone lengthening, and the time of removing the external fixator can be guided by clinical manifestation. But ordinary X-ray can not evaluate the condition of bone lengthening in the early stage of callus formation. Therefore, there are some limitations for the early regulation of the speed of distraction osteogenesis. X ray can not observe the blood flow signal in the prolonged region, and in the case of vascular and nerve traction injury, Complications such as vesicles in the lengthened area can not be monitored, and X-ray can only describe the callus in the lengthened area qualitatively rather than quantitatively. Ultrasonic monitoring of the bone lengthening process has its own advantages. Especially in the early stage of lengthening the hematoma in the lengthening area, the hematoma can not be visualized by X-ray, while the ultrasound can obviously observe that the ultrasound can detect the callus earlier and evaluate the amount of callus. This allows medical workers to adjust the speed of the stretch earlier according to the monitoring results to avoid, for example, delayed healing. The occurrence of complications such as premature healing. For other complications such as prolonged areas such as liquid vesicles can also be detected in time. In addition, ultrasound can monitor the blood supply around the prolonged area, Therefore, the formation of callus is predicted. At the same time, ultrasound also has the advantages of convenient carrying, non-invasive, quick and convenient examination, low cost, no radiation, However, ultrasound has some limitations to prolong the monitoring of late bone mineralization stage, so that it can not guide the time of removing the external fixator. At the same time, the ultrasonic imaging is not intuitive enough for the limb force line performance. There are some limitations in quantitative monitoring of callus by ultrasound. Conclusion the ratio of X ray and ultrasound have their own merits and demerits. There is no substitute for each other in the process of monitoring bone lengthening. If these two methods are combined in the process of monitoring bone lengthening, the evaluation criteria for bone lengthening will be optimized.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R683;R445.1

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