異壓性骨壞死之職業傷害及高壓氧治療

Dysbaric Osteonecrosis and Introduction of Hyperbaric Oxygen Therapy

陳興漢(Hsing-Han Chen) ； 牛柯琪(Ko-Chi Niu) ； 郭年泰(Nian-Tai Kuo)

《中華職業醫學雜誌》 1卷3期 (1994/07) Pp. 110-118

摘要

異壓性骨壞死其同義字亦可稱之為無菌性骨壞死，潛水病骨壞死或無血管性骨壞死，其造成骨壞死的原因並非由致病性的微生物所引起。1912年Bornstein和Plate首先由500位罹患減壓病的潛水人員，發現異壓性骨壞死的病歷。潛水人員造成異壓性骨壞死的發病率，因工作習性不同而有相當大的差異性。造成異壓性骨壞死的致病機轉，一般認為與工作人員呼吸壓縮空氣後，因減壓時間不足，致骨骼內氮氣泡堆積有關。這些骨骼內氮氣泡的堆積量與亨利定率有關。異壓性骨壞死的早期於臨床上並無任何明顯的症狀，但可由放射線長骨X－光檢查作早期診斷。放射線診斷分為兩類：（1）A病灶為近關節處的病灶，好發部位為髖關節，肩關節，和膝關節（2）B病灶為骨骼頭部，頸部及骨幹的病灶，好發部位為股骨幹和肱骨幹。異壓性骨壞死的發生，可能為減壓病的後遺症。A病灶異壓性骨壞死依骨壞死程度而有不同因治療方式。異壓性骨壞死的預防措施包括了（1）暴露在異常大氣壓工作之前，先接受長骨X－光檢查，以作為日後長骨X－光片檢查的原始對照資料（2）定期每兩年接受長骨X－光片檢查（3）罹患減壓病後立即及四個月後分別接受長骨X－光片檢查。對於任何曾呼吸高壓空氣和常暴露在大於40英呎（12公尺）深度以下的工作人員，均應警覺到身體骨骼有可能造成異壓性骨壞死的職業傷害發生。

關鍵字

異壓性骨壞死 ； 氮氣泡 ； 減壓病

並列摘要

Dysbaric osteonecrosis, which has been variously termed aseptic bone necrosis, caisson disease of bone or avascular bone necrosis – necrosis of joints without prior pathological organism invasion, was first described by Bornstein and Plate in 1912, associated with 500 cases of decompression sickness in the caisson workers. The incidence of dysbaric osteonecrosis among diversis was variable. The pathogenesis of dysbaric bone necrosis may be due to gaseous nitrogen accumulation in the most vascular areas of bone. This accumulation is in accordance with Henry’s Law. Early lesions are usually asymptomatic and may currently be detected only by radiological examination. There are two major sites of bone lesions, which are classified as follows: (1) type A of juxta-articular bone lesions, the most common sites are the hips, shoulders and knees, (2) type B of head, neck and shaft bone lesions, the most common sites are the shafts of the femur and humerus. Dysbaric osteonecrosis is thought to be a long term manifestation of decompression sickness. The treatment of type A lesion should be based on the fact that dysbaric osteonecrosis often progresses through the stages. The prevention of dysbaric osteonecrosis includes: (1) long bone X-ray be taken before any exposure to hyperbaria, (2) two-yearly long bone X-ray routine examination, and (3) X-ray examination immediately and four months after decompression sickness. All workers who exposed to compressed air and frequent hyperbaric conditions at depths greater than 40 feet (12 meters) are aware of dysbaric osteonecrosis.

並列關鍵字

dsbaric osteonecrosis ； nitrogen bubbles ； decompression sickness