| 引用本文: |
谢文鹏,张永奎,毕荣修,陈彦华,李永,房卫华.基于MRI确定Cierny-Mader 4期慢性骨髓炎截骨范围的临床研究[J].湖南中医药大学学报,2018,38(7):818-822[点击复制] |
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| 基于MRI确定Cierny-Mader 4期慢性骨髓炎截骨范围的临床研究 |
| 谢文鹏,张永奎,毕荣修,陈彦华,李永,房卫华 |
| (山东中医药大学, 山东 济南 250014;山东中医药大学附属医院, 山东 济南 250014) |
| 摘要: |
| 目的 确定一种适用于Cierny-Mader 4期慢性骨髓炎患者的最佳截骨标准。方法 选取山东中医药大学附属医院骨科自2014年1月至2016年3月期间收治的Cierny-Mader 4期慢性骨髓炎患者70例进行回顾性分析研究，其中以X线为向导者30例，以MRI为向导者40例。所有患者均在影像学资料向导下进行彻底病灶清除后外固定架固定治疗。术后应用敏感抗生素，定期随访，检测静脉血C反应蛋白（CRP）、血沉（ESR）、血常规（白细胞WBC、中性粒细胞绝对值NEUT＃、中性粒细胞百分比NEUT%）以及肌力（MTT评定表）、肌张力（肌张力评定量表）、关节活动度（中立位0°法）、协调和平衡能力（简易平衡评定法）、骨性愈合时间等指标，观察骨髓炎复发率，并依据Enneking评分标准评估患者的肢体功能恢复情况。结果 所有病例均得到随访，平均随访（12.2±3.2）月，以X线为向导的Cierny-Mader 4期慢性骨髓炎患者复发率为16.7%，明显高于以MRI为向导的患者复发率（7.5%），且以MRI为向导的肢体功能恢复情况（优良率87.5%）明显优于以X线为向导者（优良率66.7%），两组数据差异有统计学意义（P<0.05）。结论 以MRI为向导确定Cierny-Mader 4期慢性骨髓炎的病灶范围，并据此分别向远近端扩大0.5 cm进行截骨的方法具有治疗复发率低、肢体功能恢复良好的优点，是Cierny-Mader 4期慢性骨髓炎的最佳病灶清除标准。 |
| 关键词: Cierny-Mader 4期慢性骨髓炎 截骨范围 MRI X线 |
| DOI：10.3969/j.issn.1674-070X.2018.07.024 |
| 投稿时间：2018-02-26 |
| 基金项目: |
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| A Clinical Study of MRI-based Determination of Osteotomy Sites for Cierny-Mader Stage 4 Chronic Osteomyelitis |
| XIE Wenpeng,ZHANG Yongkui,BI Rongxiu,CHEN Yanhua,LI Yong,FANG Weihua |
| (Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, China;Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, China) |
| Abstract: |
| Objective To determine the optimal osteotomy criteria for Cierny-Mader stage 4 chronic osteomyelitis. Methods A retrospective analysis was performed on 70 patients with Cierny-Mader stage 4 chronic osteomyelitis who were admitted to our hospital from January 2014 to March 2016. In those patients, 30 received X-ray-guided treatment and 40 received MRI-guided treatment. All patients were treated with external fixators after complete removal of lesions according to the imaging data. After surgery, all patients received sensitive antibiotics and regular follow-up. Measurements were performed on C-reactive protein, erythrocyte sedimentation rate, blood (white blood cell, absolute neutrophil count, and percentage of neutrophils), muscle strength (Manual Muscle Test), muscle tension (muscle tension scale), joint range of motion (0-degree neutral position method), ability of coordination and balance (simple balance assessment), and time to bone healing. The recurrence rate of osteomyelitis was observed. The recovery of limb function was evaluated according to the Enneking scoring criteria. Results All patients were followed up with a mean follow-up time of (12.2±3.2) months. The patients with Cierny-Mader stage 4 chronic osteomyelitis undergoing X-ray-guided treatment had a significantly higher recurrence rate than those undergoing MRI-guided treatment (16.7% vs 7.5%, P<0.05). Moreover, the patients undergoing MRI-guided treatment had significantly better recovery of limb function than those undergoing X-ray-guided treatment (rate of excellent and good recovery:87.5% vs 66.7%, P<0.05). Conclusion To determine the osteotomy sites for patients with Cierny-Mader stage 4 chronic osteomyelitis, lesion sites are identified by MRI and expanded to the distal and proximal ends by 0.5 cm. It is the optimal lesion-removing criteria for Cierny-Mader stage 4 chronic osteomyelitis, which allow for a low recurrence rate and satisfactory recovery of limb function. |
| Key words: Cierny-Mader stage 4 chronic osteomyelitis osteotomy site magnetic resonance imaging X-ray |
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