超声监测下长骨骨折复位髓内针固定术的可行性初探  

Feasibility of Long Bone Fractures With Intramedullary Nail Fixation Under Ultrasound Monitoring

作　　者：张志桐[1] 申素芳[2] 胡长青[1] 王顺义[1] 马战备[1] 李辉[1] 

机构地区：[1]保定市第一中心医院骨一科,河北保定071000 [2]保定市第一中心医院超声科,河北保定071000

出　　处：《中国医疗设备》2014年第3期161-163,92,共4页China Medical Devices

摘　　要：目的评价术中超声监测闭合性复位长骨骨折行髓内针固定的临床效果。方法使用GE VIVID S6、VIVID E9实时超声诊断仪,对19例股骨干骨折及15例肱骨干骨折患者实施超声监测下闭合复位髓内针内固定术。术中根据超声检查了解骨折移位情况及是否存在神经血管损伤。在超声监测下将导丝引入骨折远端行骨折复位,将合适的髓内针送入髓腔,然后锁钉固定。根据术中超声检查结果决定是否切开修复神经血管。结果临床19例股骨干骨折及15例肱骨干骨折手术均顺利完成,术后X线显示骨折复位良好,同一术者与既往C-臂X机监测下手术时间接近。1例桡神经损伤患者超声检查延续性良好,未行切开修复,患者3周后开始恢复神经功能,3个月后神经功能完全恢复。结论术中超声引导下行长骨骨折复位安全、可靠、费用低廉、临床效果良好,便于了解神经血管损伤情况,可以在一定程度上避免医、患双方暴露于放射线下。Objective To evaluate the clinical results of closed reduction of long bone fiactures intramedullary nailing under intraoperative ultrasound monitoring. Methods Closed reduction and intramedullary nail fixation in 19 cases of of femoral shaft fracturesand 15 cases of humeral shaft fractures were conducted under ultrasound monitoring of GE VIVID S6 andVIVID E9. Fracture displacement and nerves and blood vessels damages were detected with ultrasound. The guidewire was introduced into distal fi＇acture, and intramedullary nail was sent into the medullary cavity aRer fracture reduction, then screw fixation was conducted. According to the results of intraoperative ultrasound examination to determine whether or not repair nerves and blood vessels. Results 19 cases of femoral shaft fiactures and 15 cases of humeral shaft fractures were successfully completed. X-ray examination of fracture reduction showed good results. The operation time was close to that monitored under previous C-arm X-ray machine. One case of radial nerve injury patients showed good continuity under ultrasound examination. Incision repair was not conducted. Recovery of neurological function started after 3 weeks and achieve complete recovery after 3 months. Conclusion Intraoperative ultrasound- guided long bone fracture reduction is proved to be safe, reliable and low-cost, and is helpful to understand the condition of neurovascular injury. Radiation exposure can be avoided to some extent.

关 键 词：外科手术 超声监测 骨折复位 髓内针固定术 长骨骨折 锁钉固定 C-臂X光机 

分 类 号：R687.33[医药卫生—骨科学] R445.1[医药卫生—外科学]