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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)m L vs.(29.40±7.17)m L],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。
Objective To investigate the value of closed reduction and intramedullary nailing in the treatment of unstable ulnar and radius fractures in children guided by high frequency ultrasound. Methods The clinical data of 60 cases of unstable ulnar and radius fractures treated with closed reduction and elastic intramedullary nail fixation in 60 children admitted to Affiliated Hospital of Chengde Medical College from October 2009 to October 2014 were collected. The experimental group of 30 cases, intraoperative high frequency ultrasound guided fracture reduction and elastic nail fixation, C-arm final fluoroscopy to determine. Control group of 30 cases, intraoperative C-arm fluoroscopy guided fracture reduction and elastic nailing fixation. Surgery by the same team of doctors to complete. The operation time, blood loss, radiation exposure and success rate of initial closed reduction were compared between the two groups. Results All the experimental groups achieved closed reduction and internal fixation without vascular and nerve injury. The final fluoroscopy of C-arm was satisfactory for the reduction and internal fixation. The operative time was shorter in the experimental group than in the control group [(22.23 ± 3.95) min vs. (29.03 ± 5.42) min], less bleeding [(18.30 ± 4.48) m L vs. (29.40 ± 7.17) m L] (1.80 ± 0.50) times vs. (6.10 ± 1.60) times], the success rate of initial closure was high (83.3% vs.63.3%), the difference was significant (P <0.05). Conclusion High-frequency ultrasound can dynamically observe the fracture morphology and internal fixation through the location of fracture ends, less radiation exposure, high initial success rate of intraoperative resection, satisfactory clinical efficacy and good clinical value.