自体骨髓移植治疗儿童股骨头缺血性坏死.docVIP

自体骨髓移植治疗儿童股骨头缺血性坏死[摘要] 目的:探讨自体骨髓移植治疗儿童股骨头缺血性坏死(简称Perthes病)的疗效。方法:对1994~2004年我院采用自体骨髓移植治疗Perthes病14例(16髋)患者的临床资料进行分析。所有患者均获随访,随访时间4~13年,平均8.3年。结果:16髋中,优6髋,良8髋,可2髋,差0髋,优良率为87.5%。结论:自体骨髓移植是治疗Perthes病的有效方法。? [关键词] Perthes病; 自体骨髓移植; 治疗? [中图分类号] R681.8; R457.7[文献标识码] A[文章编号] 1671-7562(2010)01-0057-03? doi:10.3969/j.issn.1671-7562.2010.01.016 Autograft of bone marrow for treatment of Perthes disease CHEN Xiao-gang?1 , ZHANG Xue-fei?2 (1. School of Clinical Medicine, Southeast University, Nanjing 210009, China; 2. Department of Orthopaedics Surgery, 359 Hospital, Southeast University, Zhenjiang 212001, China) [Abstract] Objective: To study the clinical effect of autograft of bone marrow for treating Perthes disease. Methods: 14 children(16 hips) with Perthes disease were treated by this way from 1994 to 2004.All patients were followed up for 4-13 years, average 8 .3years. Results: There were excellent results for 6 hips, good for 8 hips, fail for 2 hips .The rate of excellent and good results was 87.5%. Conclusion: Autograft of bone marrow is a feasible method for treating Perthes disease.? [Key words] Perthes disease; autograft of bone marrow; therapy?? 儿童股骨头缺血性坏死病(Legg-Calve-Perthes)简称Perthes病,是发生于儿童股骨头局部的自愈性、自限性畸形的非系统性疾病,是小儿特有的常见疾病。由于病因尚未确切了解,治疗方法繁杂,疗效不一。作者对1994至2004年我院收治的14例16髋在滑膜切除、钻孔减压同时采用自体骨髓移植治疗的病人进行随访,现将随访结果报道如下。? 1 资料与方法? 1.1 一般资料? 本组14例(16髋),男13例(15髋),女1例(1髋)。年龄5~13岁,平均7.4岁;病程3~30个月,平均12个月;病变部位左侧5例,右侧7例,双侧2例;有外伤史5例,1例伴有脊柱骨软骨炎。根据Catterall[1]分期,16个髋关节分为Ⅰ期2髋,Ⅱ期2髋,Ⅲ期10髋,Ⅳ期2髋? 1.2 临床表现? (1) 疼痛:主诉髋关节疼痛11例,膝关节疼痛1例,髋关节疼痛伴大腿内侧疼痛2例。Ⅰ期2例患者轻度疼痛,Ⅱ、Ⅲ、Ⅳ期12例均有不同程度疼痛,随病情延长疼痛加重。(2) 跛行:Ⅰ期2例跛行不明显,Ⅱ期2例活动后跛行,Ⅲ、Ⅳ期跛行明显,随着病情发展逐渐加重。(3) 活动障碍:Ⅰ期2例活动受限不明显,Ⅱ期2例主要表现为旋转受限,Ⅲ、Ⅳ期病人均有不同程度活动受限,主要表现髋关节外展、内旋受限。? 1.3 手术方法及术后处理? 1.3.1 手术方法 硬膜外麻醉,仰卧位,取Smith-petersen切口切开皮肤、皮下组织及筋膜,沿着臀中肌、阔筋膜张肌之间切开,游离出股外侧皮神经并保护。找出旋外侧动脉升支,切断结扎。分离臀中肌、阔筋膜张肌并向两侧牵开分离。用骨膜剥离器作髂骨骨膜下剥离附着于髂骨翼前外侧肌肉,直至髋臼上缘。然后将髂骨翼外侧面剥离的间隙与阔筋膜张肌、缝匠肌、股直肌之间的肌间隙沟通,充分显露髋关节囊的前部。“十”字形切开关节囊显露股骨头,观察股骨头形态可见:Ⅰ期