超声在四肢骨折闭合复位髓内钉内固定术中的临床应用效果

超声在四肢骨折闭合复位髓内钉内固定术中的临床应用效果

目的探讨超声在四肢骨折闭合复位髓内钉内固定术中的临床应用效果。方法选取2017年6月～2018年8月我院收治的40例四肢骨折患者作为研究对象，按照盲选方法将其分为观察组（n=20）和对照组（n=20）。对照组患者在C型臂X光机透视引导下行骨折闭合复位髓内钉内固定术治疗，观察组患者在高频超声引导下行骨折闭合复位髓内钉内固定治疗。比较两組患者的手术时间、透视次数以及术中出血量，并观察两组患者的初次闭合复位成功率、总闭合复位成功率以及并发症发生情况。结果观察组患者的手术时间明显短于对照组，透视次数以及术中出血量均明显少于对照组，差异有统计学意义（P＜0.05）。观察组患者的初次闭合复位成功率、总闭合复位成功率均高于对照组，并发症发生率显著低于对照组，差异有统计学意义（P＜0.05）。结论四肢骨折患者在高频超声引导下行骨折闭合复位髓内钉内固定治疗，能够动态观察骨折形态，减少放射损伤，提高术中初次复位成功率，临床效果显著，值得大力推广和应用。

[Abstract] Objective To explore the clinical effect of ultrasound in closed reduction of limb fractures and intramedullary nail fixation. Methods Forty patients with limb fractures from June 2017 to August 2018 treated in our hospital were selected as research objects and divided into observation group （n=20）and control group （n=20）according to the method of blind selection. The control group was treated with closed reduction and intramedullary nail fixation under the guidance of C-arm fluoroscopy and the observation group was treated with closed reduction and intramedullary nail fixation under the guidance of high-frequency ultrasound. The operation time，fluoroscopy times and bleeding volume were compared between the two groups. The success rate of primary closed reduction，total success rate of closed reduction and complications were observed. Results The operation time in the observation group was significantly shorter than that in the control group，the number of fluoroscopy was significantly fewer that in the control group，the amount of bleeding during operation were significantly less than that in the control group，and the differences were statistically significant （P＜0.05）. The success rate of primary closed reduction and the total success rate of closed reduction in the observation group were higher than those in the control group，the incidence rate of complications in the observation group was significantly lower than that in the control group，and the differences were statistically significant （P＜0.05）. Conclusion High-frequency ultrasound-guided closed reduction and intramedullary nail fixation for extremity fractures can dynamically observe the fracture morphology，reduce radiation damage，and improve the success rate of primary reduction. The clinical effect is remarkable，which is worthy of vigorous promotion and application.

[Key words] Ultrasound scan；Limb fracture；Closed reduction fixation and intramedullary nail；Application effect骨折的发生主要是由于交通意外、重物撞击、高空坠落伤等所致，四肢骨折是全身骨折中最为常见的类型[1-2]。目前临床治疗四肢骨折常采用闭合复位弹性髓内钉内固定治疗。传统术式手术切开复位创

伤大，术中易破坏患者骨膜，引发血供不足，导致术后易出现疼痛、瘢痕粘连、感染等并发症，不利于患者的术后恢复，对患者的生存质量造成严重影响[3]。在C型臂X光机透视下指导骨折復位及弹性髓内钉置入治疗中，虽然X线片检查是复位效果判定的金标准，但X线检查对患者的身体损害较大[4]。而超声检查操作便捷，具有较高的敏感性和特异性，能够动态观察与评估患者的肌肉、骨折、血管以及神经损伤[5]。本研究就超声在四肢骨折闭合复位髓内钉内固定术中的临床应用效果进行探讨，现报道如下。

1资料与方法

1.1一般资料

选取2017年6月～2018年8月我院收治的40例四肢骨折患者作为研究对象，按照盲选方法将其分为观察组（n=20）和对照组（n=20）。观察组中，男11例，女9例；年龄24～80岁，平均（52.1±3.6）岁；其中上肢骨折患者9例，下肢骨折患者7例，合并上下肢骨折患者4例。对照组中，男10例，女10例；年龄25～81岁，平均（53.4±3.7）岁；其中上肢骨折患者8例，下肢骨折患者8例，合并上下肢骨折患者4例。两组患者的性别、年龄、骨折部位等一般资料比较，差异无统计学意义（P>0.05），具有可比性。纳入标准：体征及影像学检查均证实为四肢骨折者；受伤后近1周左右的新鲜闭合性骨折者。排除标准：病历资料不完整者；开放性骨折者；行逆行置钉固定者。本研究经医院医学伦理委员会审核批准，所有患者均知情同意并签署同意书。

1.2治疗方法

观察组患者在高频超声引导下行骨折闭合复位髓内钉内固定治疗。仪器采用LOGIQ BOOK XP彩色多普勒超声诊断仪，探头线阵为i12L-RS、10Lb-RS。给予患者全麻，帮助其取仰卧位，切开螺内钉置入处，切口长度约2 cm，使用高频超声检查骨质开口位置，开口器打开开口。在超声引导下，明确骨折的成角与缩短情况，对患者的肢体行纵向牵引，对骨折缩短畸形进行牵引，后对挂着侧方移位进行矫正。经B超在各方位动态监测可见骨折四周不连续强回声线变为一条轴线，提示骨折复位良好。后在骨质开口处沿着髓腔将髓内钉导丝穿过骨折处，并一次沿着导丝进行扩髓，根据患者的骨折断端情况选择合适的髓内钉，置入导针进行固定。术毕在C型臂X光机透视下确定复位效果，若髓钉长度适中，骨折复位良好，将锁钉钉入髓内钉两端，对切口进行逐层缝合，并使用无菌辅料包扎固定。

对照组患者在C型臂X光机透视引导下行骨折闭合复位髓内钉内固定术治疗。手术方式与观察组相同，但当髓内钉到达骨折断端时，在C型臂X光机透视引导下行骨折复位与固定，固位手术完成后，将弹性髓内钉钉尾剪短，并埋于皮下，对切口进行逐层缝合，并使用无菌辅料包扎固定。

1.3观察指标