高频超声在儿童胫骨骨折弹性髓内钉内固定术中的应用价值

Application value of ultrasound in the pediatric tibial fractures with elastic intramedullary nail fixation

关键词:  儿童  胫骨骨折  闭合复位  高频超声  弹性髓内钉

Key words:  children  tibial fractures  closed reduction  ultrasound  elastic intramedullary nail

摘要:

目的　评估高频超声在儿童胫骨骨折弹性髓内钉内固定术中的应用价值。方法　回顾分析2009年1月至2015年1月于承德医学院附属医院行闭合复位的50例儿童胫骨干骨折患儿的临床资料。其中25例在高频超声监视下，应用弹性髓内钉行闭合复位内固定，最终C型臂透视确定，即高频超声组；25例C型臂引导下应用弹性髓内钉行闭合复位内固定，即对照组，所有手术由同一组医师完成。 对两组的手术时间、出血量、C型臂透视次数、术后住院时间、愈合时间、内固定取出时间及手术并发症进行比较分析。结果　两组手术时间、术后住院时间、愈合时间、内固定取出时间和手术并发症间比较均无明显差异（P>0.05）。高频超声组出血量为 (17.44±3.96)mL,低于对照组(23.32±55.71)mL，差异有统计学意义（P<0.05）。高频超声组C型臂透视次数为（2.16±0.47）次少于对照组（5.60±1.50）次，差异有统计学意义（P<0.05）。结论　高频超声在儿童胫骨骨折弹性髓内钉内固定术中临床疗效可靠，避免放射线的暴露，出血少，可以动态观察骨折复位，减少血管及神经损伤的几率，有很好的临床应用前景。

Abstract:

Objective 　 To evaluate the value of ultrasound-guided technology in the pediatric tibial fractures using elastic intramedullary nail fixation.　Methods 　 The clinical data of 50 pediatric patients, who had tibial fractures and received closed fixation with elastic intramedullary nail from January 2009 to January 2015 in Affiliated Hospital of Chengde Medical College, were retrospectively analyzed. In the ultrasound group (n=25), ultrasound monitoring was used to guide the operation of reduction with elastic intramedullary nail fixation, which was eventually identified by C arm fluoroscopy. In the control group (n=25), C arm fluoroscopy was used to guide the operation. All of the surgeries were performed by the same group of physicians. The operation time, blood loss, C arm fluoroscopy times, postoperative length of hospital stay, bone healing time, time of internal fixation removed and complications dates were analyzed and compared between the two groups.　Results 　 The operation time, postoperative length of hospital stay, bone healing time, time of internal fixation removed and complications were not significantly different between the two groups (P>0.05). Compared with the control group, the ultrasound group had less blood loss (17.44±3.96) mL, fewer radiation exposure (2.16±0.47) time; the differences were statistically significant (P<0.05).　Conclusions 　 Ultrasound-guided technology in pediatric tibial fractures with elastic intramedullary nail fixation has satisfactory clinical effects with less radiation exposure and blood loss, can dynamically observe the fracture, reduces the risk of vascular and nerve injury, and has great value in clinical application.