DEXA对骨髓炎骨缺损治疗中骨痂密度的评价

目的：探讨DEXA对骨髓炎骨缺损治疗中骨痂密度的评价及意义。方法：严格按照纳入排除标准,选取21例骨髓炎清创后伴大段皮质骨缺损一期植骨的病人。术后4,6,8,10个月后对骨折端骨痂行双能X线骨密度仪检测,并进行X摄片以及Enneking评分,从而明确植骨区愈合骨痂的密度变化趋势,骨愈合情况以及症状改善情况。结果：（1）X线摄片结果显示：4个月后：骨缺损区依然清晰可见,内有少量稀疏骨痂通过,少量外骨痂形成。6个月后：植骨区内骨痂含量明显增多,且外骨痂膨大。8个月：缺损区模糊,有较致密骨痂生成,且外骨痂逐渐减少。10个月：植骨区骨痂更加致密,且部份髓腔再通。（2）Enneking评分：患者术后第10个月功能恢复情况评估正常功能20例,20分以下的患者1例。（3）BMD测定：骨折端的骨密度及骨密度比率随时间延长而增加,植骨10个月后患侧的骨密度已可基本上达到正常对照侧的骨密度水平。结论：双能X线骨密度测量从一定程度上反映出骨痂的力学强度特性。在感染性骨缺损治疗中可以作为检测植骨区的恢复情况的参考。

Evaluation of the Bone Callus Density with Dual Energy X-ray Absorptiometry in Bone Defect Healing with Chronic Osteomyelitis

Objective： To evaluate the bone callus density with Dual Energy X-ray Absorptiometry（DEXA） in theprocess of bone defect healing with chronic osteomyelitis.Methods： 21 patients of osteomyelitis with large section of cortical bone defect were selected for the examination of bone callus quantity by DEXA.The X-ray radiography and Enneking bone healing score were used to at the same time to evaluate the bone healing at 4,6,8,10 months post operation.Results：（1） X-Ray radiography results： after 4 months,the bone defect area are still clear,there were a few sparse callus passing through,a small amount of callus formed.After six months,content of callus increased obviously in the bone graft area.8 months later,the defect became fuzzy,with dense callus formation,The callus surrounding the bone defect were reduced gradually.By 10 months,more dense callus appeared in the bone graft area,and the recanalization of the medullary cavity appeared.（2） Enneking score： 20 cases achieved normal function recovery postoperatively,with only 1 patient had partly t recovery.（3） The bone mineral density（BMD） measurement： the bone mineral density and bone mineral density ratio increased with time extension,the BMD of autologous bone graft area achieved normal level compare with the control side after 10 months.Callus density of bone graft area can gradually increase as normal as the contralateral side bone density.Conclusion： the BMD of the bone defect callus measurements by DEXA can explain the healing of strength character of the callus,and the DEXA is an ideal method to evaluate the recovery of the of bone defect callus density in fracture healing process of osteomyelitis.