X線和彩色多普勒超聲檢查在肢體延長中的應(yīng)用價(jià)值

1、X線和彩色多普勒超聲檢查在肢體延長中的應(yīng)用價(jià)值        【中文摘要】目的制作日本大耳白兔脛骨干截骨延長模型,利用普通X線、彩色多普勒超聲觀察肢體延長過程中延長區(qū)域骨痂生長及血運(yùn)情況,觀察延長區(qū)早期骨痂天生及變化特點(diǎn),猜測發(fā)展趨勢。比較普通X線和多普勒超聲檢查在肢體延長監(jiān)測中的優(yōu)缺點(diǎn),探討兩種檢查方法在肢體延長術(shù)中的監(jiān)測價(jià)值。方法15只健康成年日本大耳白實(shí)驗(yàn)兔(均勻5±0.5月齡),重量2.5-2.8Kg,全麻下于右后肢安裝單臂外固定支架并行脛骨干上1/3線鋸截骨,制作肢體延長模型。術(shù)后7天開始延長,

2、速率為1mm/d,分早晚兩次完成,延長到30%(延長區(qū)域的長度/脛骨原長度)后停止延長,礦化5周。在延長及礦化過程中應(yīng)用彩色多普勒超聲檢查延長區(qū)域骨痂形成的聲像特點(diǎn)及血運(yùn)情況,并與相應(yīng)時(shí)相點(diǎn)的X線比較。另外術(shù)前術(shù)后檢查丈量鄰近關(guān)節(jié)(膝、踝關(guān)節(jié))活動度的改變。術(shù)前通過正常肢體的普通X線丈量動物脛骨長度及脛骨上下直徑的變化,從而確定延長的長度及外固定支架使用半針直徑的大小。術(shù)后通過X線觀察肢體延長長度及延長區(qū)域骨痂生長情況。結(jié)果1大體觀察:術(shù)前正常實(shí)驗(yàn)動物膝、踝關(guān)節(jié)活動正常;延長過程中,延長10%時(shí),膝、踝關(guān)節(jié)活動度與術(shù)前正常相比變化不明顯(p0.05);延長到20%和30%時(shí),踝關(guān)節(jié)背伸功能明顯

3、受限(P0.01),差異有統(tǒng)計(jì)學(xué)意義。膝關(guān)節(jié)伸直功能受限(P0.05),礦化5周后,關(guān)節(jié)功能都有一定改善,但是仍不能恢復(fù)到正常(P0.05)。2 X線片表現(xiàn):脛骨延長到10%之前,延長區(qū)域看不到新生的骨痂,延長到20%時(shí),可以看到在延長區(qū)域模糊的骨痂影像。延長到30%,骨痂量明顯增加,在截骨端開始出現(xiàn)骨皮質(zhì)。礦化3周時(shí),兩真?zhèn)€骨皮質(zhì)開始匯合,逐漸出現(xiàn)髓腔。礦化5周時(shí),延長區(qū)域骨痂豐富,皮質(zhì)骨和髓腔分界清楚,但是中間匯合區(qū)域愈合薄弱。礦化7周,延長區(qū)域骨痂愈合堅(jiān)強(qiáng),往除外固定支架,延長肢體力線佳,沒有出現(xiàn)畸形愈合。3彩色多普勒超聲表現(xiàn):延長初期(3-5天),多普勒超聲聲像圖顯示延長區(qū)血流信號逐漸

4、增加。延長一周左右,多普勒超聲聲像圖顯示延長區(qū)出現(xiàn)高回聲區(qū),表明有骨痂天生。延長到30%時(shí),超聲波已經(jīng)很少能透過延長區(qū)域,截骨端皮質(zhì)骨形成,延長區(qū)間的裂隙減小,多普勒超聲已經(jīng)很難再正確丈量出實(shí)際的延長長度。延長區(qū)域應(yīng)用超聲探頭連續(xù)的橫斷掃描影像表現(xiàn)為無回聲的窗口,隨著新骨的形成,在延長區(qū)域超聲回聲逐漸增強(qiáng),慢慢填補(bǔ)空隙?？v切面超聲掃描影像表現(xiàn)為截骨的兩個(gè)斷端表現(xiàn)為高反射,超聲波無法透過皮質(zhì),在延長區(qū)域,超聲波部分透過未礦化完全的新生骨痂區(qū)域,呈現(xiàn)為斑點(diǎn)狀。結(jié)論肢體延長經(jīng)常導(dǎo)致關(guān)節(jié)活動范圍的減小,以踝關(guān)節(jié)背伸障礙為主。應(yīng)用普通X線片可以術(shù)前丈量擬延長肢體的長度及肢體上下端直徑的變化,從而確定延長

5、的幅度和使用相配套的外固定支架及半針的大小。術(shù)后可以通過X線觀察是否截骨完全,截骨端對位及力線。在延長過程中,X線不僅可以確定延長區(qū)域的長度及骨痂天生的多少,而且可以觀察延長肢體的力線,是否出現(xiàn)軸向偏移,外固定支架是否松動,是否有感染等。多普勒超聲可以早期觀察到延長區(qū)域血運(yùn)形成情況及骨痂天生的多少,較之X線更能早期猜測肢體延長區(qū)域骨痂愈合的趨勢及預(yù)后,對肢體延長的速度起到指導(dǎo)作用。另外多普勒超聲可以在延長過程中發(fā)現(xiàn)一些液性并發(fā)癥,例如囊腫。而且超聲檢查是一種無創(chuàng)且經(jīng)濟(jì)實(shí)用的檢查方法。肢體延長過程中,普通X線和超聲檢查各有優(yōu)缺點(diǎn),假如將兩者聯(lián)合應(yīng)用,將對肢體延長的成功提供更正確的信息。'

6、);【Abstract】 Objective To establish rabbit models of tibia diaphyseal lengthening.To observe and analysis the blood circulation and the new callus at the osteotomy site with X-ray and color doppler ultrasound.To investigate the changed information of the new callus at the lengthening area in the ear

7、ly stage.To compare the advantage and disadvantage between the two methods during limb lengthening.To discuss the Monitoring value of the two evaluated methods.Methods The average age of the fifteen healthy rabbits was 5.0±0.5 months and their mean weight was 2.5-2.8 Kg.The rabbit models were e

8、stablished under general anaesthesia by means of the upper third of tibia osteotomy and slow traction for lengthening.Lengthening was commenced traction seven days after surgery at a rate of 1mm twice a day.Lengthening was continued to increase 30%over initial bone length and stopped to be mineraliz

9、ed for 5 weeks.With the color doppler ultrasound to observe and analyse the blood circulation and the new callus at the osteotomy site at different stages during limb lengthening,we compare the the outcome between ultrasound and X-ray.In addition,we need to examine the active range of the knee and a

10、nkle joint before and after surgery.With the X-ray to measure the length and diameter of the tibia before surgery,we make sure the length needed to lengthen and the diameter of the half pins.Also,we could observe the length and the new callus at the lengthening area and the limb alignment with the X

11、-ray after surgery.Results 1 Common observation:All animals passed the operative period,no one was infected,even osteomylitis during limb lengthening.When the limb was lengthened to a increase of 10%over initial bone length,the active range of the knee and ankle joint was not obviously different(p0.

12、05).When the limb was increased 20%and 30%over initial bone length,the dorsal flexion range of ankle joint was serious limited(P0.01),the outcome was significant.After 5 weeks mineralized,the function of the joints was improved,but was not recovered to be normal(P0.05). 2 X-ray:When the limb is leng

13、thened to 10%increased,there was no clear evidence of new bone formation within the traction sites.When the limb is lengthened to 20%, we can see small amount callus at the osteotomy site.When lengthened to 30%,there is much more callus at the lengthening area,and the cortical bone appeared at both

14、ends.Three weeks mineralized later,the cortical bone of the both ends get in touch with each other and the medullary cavity has appeared.After 5 weeks mineralized, the amount of callus at the traction site is larger than before,and cortical bone and medullary cavity are classified,but the mid-part i

15、s thin.After 7 weeks mineralized, the callus is union.We remove the external frame with no deformity and good alignment of the limb.3 Ultrasound:In the early stage(3-5 days after surgery),the amount of the micrangium and the rate of blood flow increased and then decreased gradually.After 1 week,we c

16、an see some speckled echogenic at the traction site that means new bone has formed.When the limb is lengthened to 30%,the ultrasound islands coalesce and the accuracy of gap measurement is reduced.Serial longitudinal ultrasound scans showed the traction gap as an echolucent window.New bone appeared

17、as echogenic islands which became aligned longitudinally and progressively increased to fill the window.From the transverse ultrasound images,the proximal and distal segments of bone were seen as hyper-reflecting lines.At the site of the traction gap,these lines broke up into speckled echogenic area

18、s corresponding to the presence of immature new bone.Conclusions Limb lengthening usually results in the function of the joint limited, especially dorsal flexion range of ankle joint.With X-ray,we can measure the length and diameter of the tibia before surgery,and then make sure the length needed to lengthen and the diameter of the half pins.After operation,we can observe the limb a