骨关节固定综合征

Immobilization Syndrome of Bone and Joint

26只狗分别采用不同刚度钢板固定完整胫骨,观察不同时期骨血运、结构、骨钙及力学性能的改变,与12只狗一侧后肢采用石膏固定作比较。8例胫骨骨折患者梯形钢板(TCP)固定治愈;取钢板后做CT扫描测骨密度和皮质骨厚度,与4例采用长腿石膏牵引及外固定器固定、2例用TCP固定骨愈合未恢复正常负重功能者比较。结果表明钢板固定后出现骨质疏松的原因除应力遮挡外,早期与创伤及血运障碍有关,中后期主要由于感染或金属反应及肢体废用。而石膏固定后期表现以骨萎缩为主。钢板固定引起的骨质疏松,在肢体正常负重4～6月后恢复,可无肌萎缩。作者认为骨关节长期固定后的肢体慢性水肿、疼痛、骨质疏松及肌肉萎缩应称为骨关节固定结合征,可通过选择适当固定方法、肢体早期活动及正常负重进行防治。

Twenty-six intact canine tibiae were fixed by 3 types of plate with various rigidities. The blood supply, structure, calcium and mechanical properties of bone were investigated at different stages and compared to 12 canine tibiae fixed with plaster. Eight patients with tibial shaft fractures treated by trapezoidal plate (TCP) were scanned with CT after plate removal. The bone density and the thickness of the cortex were determined and compared to 4 patients fixed with plaster, traction and external fixater, repectively. The results demonstrated that the causes of osteopenia after plating was various, in addition to stress shielding, the disturbance of blood supply and trauma contributed to the early osteoporotic changes of bone. The metal reaction and disuse of the affected limb were the main factors at the later stage. Long term plaster fixation mainly caused bone atrophy. Osteoporosis and muscular atrophy following bone and joint fixation should be termed immobilization syndrome of bone and joint, which can be treated and prevented by early exercises and normal weight-bearing.