高频超声在儿童不稳定尺桡骨骨折靶向引导弹性髓内钉内固定中的应用

Application of ultrasound in guiding elastic intramedullary nail fixation for children with unstable forearm fractures

关键词:  儿童  尺桡骨骨折  高频超声  闭合复位

Key words:  children  forearm fracture  ultrasound  closed reduction

摘要:

目的　探讨高频超声术中引导儿童不稳定尺桡骨骨折闭合复位弹性髓内钉内固定的应用价值。　方法　收集承德医学院附属医院2009年10月至2014年10月收治的60例儿童不稳定尺桡骨骨折闭合复位弹性髓内钉内固定的临床资料。实验组30例，术中应用高频超声引导骨折闭合复位弹性髓内钉内固定，C型臂最终透视确定。对照组30例，术中应用C型臂透视引导骨折闭合复位弹性髓内钉内固定术。手术均由同一组医生团队完成。对两组手术时间、出血量、射线暴露及初次闭合复位成功率进行比较分析。　结果　实验组全部实现闭合复位内固定，无血管及神经损伤，C型臂最终透视确定复位及内固定位置满意。实验组与对照组相比，手术时间短［（22.23±3.95）min vs.（29.03±5.42）min］，出血量少［（18.30±4.48）mL vs.（29.40±7.17）mL］，射线暴露次数少［（1.80±0.50）次vs.（6.10±1.60）次］，初次闭合复位成功率高（83.3% vs. 63.3%），差异均有显著性意义，P<0.05。　结论　高频超声可动态观察骨折形态及内固定通过骨折断端的位置，射线暴露次数少，术中初次复位成功率高，临床疗效满意，有很好的临床应用价值。

Abstract:

Objective　To investigate the effects of ultrasound technology in guiding elastic intramedullary nail fixation for children with unstable forearm fractures.　Methods　 This retrospective study included the children who had unstable forearm fractures and received closed fixation with elastic intramedullary nail. Clinical data of 60 cases between October 2009 and October 2014 in our hospital were collected. Ultrasound was used for guiding the operation of closed reduction with elastic intramedullary nail fixation in 30 cases (experimental group). C arm perspective was used finally. C arm perspective was used in guiding closed reduction of fraction with elastic intramedullary nail fixation in 30 cases (control group). All operations were performed by the same team of doctors. Operation time, blood loss, radiation exposure and successful rate of first closed reduction were compared.　Results　 All surgeries were completed successfully in the experimental group without neurovascular injury. Postoperative C arm showed the reduction and internal fixation position were satisfactory. Compared to control group, experimental group had shorter operation time ［（22.23±3.95）min vs. （29.03±5.42）min, P=0］, less blood loss ［（18.30±4.48）mL vs.（29.40±7.17）mL, P=0］, fewer radiation exposure ［（1.80±0.50）vs.（6.10±1.60）, P=0］, and higher first closed reduction success rate (83.3% vs. 63.3%, P=0.04).　Conclusion　 Ultrasound can be used to observe dynamic fracture morphology and internal fixation position through fracture end and has advantages of few radiation exposure, high first time reduction success rate, and satisfactorty clinical curative effect. It has great value in clinical application.