骨微损伤致青少年肱骨头骺缺血性坏死5例报告  

Bone microdamage to osteoavascular epiphysis caput humeralis in teenagers(5 cases report)

作　　者：刘淑坤[1] 张忠杰[1] 王清[1] 梁能[2] 王高举[1] 

机构地区：[1]泸州医学院附属医院骨科,四川泸州市646000 [2]泸州医学院附属医院放射科,四川泸州市646000

出　　处：《中国矫形外科杂志》2006年第19期1448-1452,共5页Orthopedic Journal of China

摘　　要：[目的]探讨对青少年骨微损伤性肱骨头骺缺血坏死的早期诊治要点。[方法]回顾性从2004—2005年的骨科门诊所见肩部疼痛伴肩关节活动功能障碍的138例患者中，有X线片和（或）CT、血生化的青少年5例，经中短期非手术疗效观察，结合相关文献学习，提出对临床诊治有指导意义的四期分类法。[结果]肱骨头骺微损伤致肩疼痛伴功能障碍的青少年5例。疗效观察：早期2例1～4周，中期2例5～8周，晚期1例4～6个月。用“活血化瘀”“补肾壮骨”“通络止痛”汤药内服外用，取得良好效果。（最晚期发生严重的骨性关节炎和（或）恶性变，造成严重后果的另文报道）。[结论]一次或多次肩部肱骨头微损伤可致肱骨头骺发生缺血性坏死；对出现临床症状、体征的患者，根据症状体征表现、病程长短、影像学等检查，建议分为早、中、晚及最晚4期，以利选择治疗措施；因种种原因久治未愈可发展成最晚期的病例，如严重的软骨塌陷和（或）恶性变，是手术干预的绝对适应证。[ Objective] To study Bone microdmage to osteoavascular epiphysis caput humeralis in teenagers of the guts outbreak mechanism and make a diagnosis and give treatment in early stage important point. [ Method] The review was from 138 patients of the shoulder department ache with shoulder joint movable function obstacle that orthopedics out-patient service of 2004 - 2005. There was X-rays / CT, the blood bio-chemical 5 example among the teenager of the patients, it was observed by medium short-term curative effect. We was combined a related cultural heritage study, put forward to make a diagnosis and gave treatment to have the instruction meaning to the clinic of four expect to categorize a method, and to early, medium, later period the non-surgical operation treatment observation. [ Result] In 138 patients, there were 5 teenager patients who were the epiphysis of head humeralis bone microdamage ON, through the function instauration was normal ： Earlier period 2 cases of 1 - 4 weeks, middle period 2 cases of 5 - 8 weeks, the later period 1 case of 4 - 6 months. We choose the medicine of prescription with the independence, ＂Huo xue hua yu＂, ＂Bu shen zhuanggu＂, ＂Tong luo zhi tong＂ medicinal broth, the right amount internal use outside use, having already obtained good result. We have already observated the serious bone arthritis/canceration, resulting in serious result （in another report）. [ Conclusion] Once or more shoulder was bone microdamage lead the caput epiphysis humeralis occurrence ON of guts. We observe the sufferer whom had the clinical symptom, physical sign, according to the clinical performance, course of disease＇s long/short, imageology atc. The suggestion is divided into early, medium, night and most late four periods, for the convenience of the choice treatment measure. Because of various reason, long and non-healing cases might develop to the most later period of case, such as the avascular osteo arthrids/canceration.

关 键 词：青少年 骨微损伤 肱骨头骺 骨缺血坏死 诊断和治疗 

分 类 号：R683[医药卫生—骨科学] R681.7[医药卫生—外科学]