CT联合肌骨超声在肋骨骨折术前定位中的应用  

Application of CT combined with musculoskeletal ultrasound in the preoperative positioning of rib fractures

作　　者：史聪聪 郭光伟[2] 滕飞 杨坤[1] 曹策 李强[1] 杨少俊 Shi Congcong;Guo Guangwei;Teng Fei;Yang Kun;Cao Ce;Li Qiang;Yang Shaojun(Shanxi Medical University,Taiyuan 030001,China;Department of Cardiothoracic Surgery,The Second Hospital Affiliated to Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学,太原030001 [2]山西医科大学第二附属医院心胸外科,太原030001

出　　处：《创伤外科杂志》2022年第10期753-757,共5页Journal of Traumatic Surgery

摘　　要：目的探讨多层螺旋CT三维重建联合肌骨超声在肋骨骨折内固定术前定位中的应用。方法回顾性分析2020年7月—2021年7月山西医科大学第二人民医院心胸外科手术治疗的多发肋骨骨折患者95例,应用倾向性评分匹配(PSM)的方法,最终纳入超声组与手法组各40例。男性63例,女性17例;年龄24~85岁,平均50.9岁。高处坠落伤14例,道路交通伤52例,摔伤4例,重物砸伤10例。根据骨折断端定位方式不同分为超声组和对照组,超声组行CT三维重建+超声定位,对照组行CT三维重建+手法定位。观察两组患者骨折端定位准确率、单根肋骨手术切口长度、手术时长、术后2d视觉模拟评分(VAS)、住院天数、切口愈合等级、手术当日胸壁引流量等指标。结果超声组骨折端定位准确率高于对照组(92.6%vs.71.7%,P<0.05),单根肋骨手术切口长度[(2.5±0.8)cm vs.(3.2±1.0)cm]、术后2d VAS[(3.8±0.8)分vs.(5.2±1.4)分]、总住院天数[(18.45±6.1)d vs.(23.87±8.8)d]、手术当日胸壁引流量[(109.18±54.59)mL vs.(150.25±71.66)mL]与对照组比较,差异有统计学意义(P<0.05);超声组手术时长与对照组[(107.75~206)min vs.(104~172.25)min]比较差异无统计学意义(P>0.05)。超声组切口均甲级愈合,无伤口感染、脂肪液化、裂开等并发症;对照组切口甲级愈合36例,伤口红肿、脂肪液化3例,伤口感染1例。28例连枷胸患者术后反常呼吸消失;所有患者术后胸廓畸形消失,术后1个月复查胸部X线片,内固定在位,无脱落。结论CT三维重建联合超声在肋骨骨折内固定术前定位的准确率高,有效缩短手术切口长度及住院时间,减轻患者疼痛,有利于术后恢复。Objective To explore the application of multi-slice CT(MSCT)three-dimensional(3D)reconstruction combined with musculoskeletal ultrasound in the preoperative localization of the ends of multiple rib fractures before internal fixation surgery.Methods We retrospectively analyzed the clinical data of 95 patients with multiple rib fractures admitted to the Department of Cardiothoracic Surgery in the Second Hospital of Shanxi Medical University from Jul.2020 to Jul.2021,then the propensity score matching was adopted for calculation to include 40 patients in each group.Including 63 males and 17 females.The age ranged from 24 to 85 years,with an average of 50.9 years.Including 14 cases of falls from height,52 cases of traffic injuries,4 cases of falls and 10 cases of hit by heavy objects.Location of the fracture ends was determined by either MSCT 3D reconstruction+manual positioning(control group)or MSCT 3D reconstruction+musculoskeletal ultrasound(ultrasound group).The accuracy of fracture end positioning,length of the surgical incision on a single rib,operation time,visual analogue scale(VAS)score at postoperative 2d,length of hospital stay,wound healing grade,and chest drainage volume on the day of surgery were observed.Results Fracture end positioning was more accurate in the ultrasound group than in the control group(92.6%vs.71.7%,P<0.05).Moreover,the surgical incision length on a single rib[(2.5±0.8)cm vs.(3.2±1.0)cm],VAS at postoperative 2d(3.8±0.8 vs.5.2±1.4),the length of hospital stay[(18.45±6.1)d vs.(23.87±8.8)d]and the chest drainage volume on the day of surgery[(109.18±54.59)mL vs.(150.25±71.66)mL]showed significant difference between two groups(all P<0.05),except the operation time[(107.75-206)min vs.(104-172.25)min](P>0.05).Wound union was achieved at one-stage for the ultrasound group,without complications of wound infection,fat liquefaction,or dehiscence.In the control group,36 cases achieved union at one-stage,3 presented with swelling and fat liquefaction,and the rest 1 case had wound infection

关 键 词：肋骨骨折 CT三维重建 超声 定位 倾向性评分匹配 

分 类 号：R683.1[医药卫生—骨科学]