探究超声在骨延长过程中的监测价值

发布时间：2018-03-22 17:24

本文选题：牵拉成骨　切入点：骨延长　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本实验通过分别用X线与超声技术监测骨延长过程中各个时间点病人骨痂形成及周围血供的情况,通过与传统监测手段X线的对比,找出超声在骨延长过程中的监测价值。方法:选取10例需要骨搬移或骨延长的病人做为实验对象。应用超声、X线分别在截骨前、截骨后、骨延长阶段、骨矿化阶段对病人进行检查。骨搬移前期阶段检查间隔时间为2周,后期可根据情况调整间隔时间。对比超声和X线所监测得到骨痂和血供的信息,得出各自的优缺点,并通过对结果的分析对病人采取相应的措施。结果:X线本身是一种放射性检查,对患者有一定损害。它可以确定患者术后截骨是否完全离断,通过X线可以准确测量延长间隙的牵拉长度,观察肢体力线,观察骨延长过程中是否存在截骨端延时愈合、不愈合、过早愈合、临近关节是否存在畸形、脱位等情况,骨延长后期阶段X线可以显示延长区域骨皮质和骨髓腔的形成情况,结合临床表现指导去除外固定架的时间。但是普通X线不能评价骨延长早期新生骨痂的情况,所以对于早期指导牵拉成骨的速度调节存在一定的局限性。X线无法观察到延长区域血流信号情况,并且对于血管神经牵拉伤,延长区出现囊泡等并发症也无法监测。同时X线只能对延长区骨痂进行定性的描述而无法定量的检测。超声监测骨延长过程具有他自身的优势,尤其是在牵拉延长早期的延长区域的血肿机化期,X线无法显像,而超声能明显的观察到。超声能更早的监测到新生骨痂并评价骨痂的多少,这就使得医务工作者可以更早的根据监测结果调整牵拉延长的速度以避免如延时愈合、过早愈合等并发症的发生。对于其他并发症如延长区域出现液性囊泡等超声也可以及时发现。另外超声可以监测到延长区域周围血供的情况,从而预测骨痂的形成情况。同时超声还具有方便携带、无创、检查快捷方便、费用低廉、无辐射、易接受等优点。但是超声对于牵拉延长晚期骨矿化阶段的监测有一定的局限性使其无法指导拆除外固定架时间。同时超声显像对于肢体力线表现不够直观,且无法测量后期截骨端间隙。超声对于骨痂的定量监测也有一定的局限性。结论:X线与超声各自有各自的优缺点。在监测整个骨延长过程中彼此不可替代、互相补充。如果将这两种监测手段联合应用于监测骨延长的过程中,则会更加优化骨延长的评价标准。
[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.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R683;R445.1

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