超声与透视下犬股骨骨折外固定的实验对比

An experimental study on external fixation of femoral fractures under ultrasound versus fluoroscopy in canine

[目的]探讨超声仪在监测犬股骨骨折闭合复位外固定支架手术中的效能。[方法]选择10只成年比格犬作为研究对象,实验前对双侧股骨进行X线片检查以排除肿瘤、畸形等影响,采用开放性截骨术建立股骨骨折模型。每只实验犬双侧股骨随机分配到超声组和透视组进行对照,分别在超声诊断仪及C型臂X线机辅助下行股骨骨折闭合复位外固定支架手术。术后分别摄取犬双侧股骨正侧位X线片。比较2组的手术时间、骨折复位效果和固定针深度。[结果]超声组和透视组外固定支架手术操作完成的时间分别为(34.3±1.8)min和(43.8±2.3)min,差异有统计学意义(P<0.05)。超声组、透视组术后X线片骨折对位率分别为(89.3±3.6)%和(91.6±3.7)%,术后正、侧位X线片成角分别为(4.4±1.5)°、(5.9±1.7)°和(3.5±1.1)°、(4.8±1.9)°。两组固定针深度分级,超声组:优21例,良16例,差3例,优良率92.5%;透视组:优32例,良8例,差0例,优良率100%。透视组术后骨折对位、X线正、侧位成角和固定针深度均优于超声组,但差异均无统计学意义(P>0.05)。[结论]在超声引导下,股骨骨折模型可获得满意的复位与固定,提示便携式超声仪可有效替代X线机,尤其适合野战环境下四肢骨折伤员的紧急救治。

[Objective]To explore the efficacy of ultrasound for guiding closed reduction and external fixation of extremity fracture in the canine. [Method]Ten adult beagle dogs without osteoporosis,tumor and deformities verified by radiographs were used in this experiment. Bilateral femoral fracture models were individually created by osteotomy at 6 cm above the distal end of the femur. Subsequently,fracture in each side was closely reduced and fixed with an ORTHOFIX frame,monitored with ultrasound（ the ultrasound group） or fluoroscopy（ fluoroscopy group） randomly. The length of operation,efficiency of fracture reduction fixation,including position and alignment of fracture reduction,and pin placement were compared between the two groups.[Result]The operative time in an average lasted（ 34. 3 ± 1. 8） min in the ultrasound group,while（ 43. 8 ± 2. 3） min in the fluoroscopy group,there was statistically significant difference between two groups（ P 0. 05）. In term of fracture reduction and fixation,the reposition percent of fractured ends was（ 89. 3 ± 3. 6） % in the ultrasound group,by contrast,（ 91. 6 ± 3. 7） % in the fluoroscopy group. In addition,the angulation of fracture was（ 4. 4 ± 1. 5） ° in the coronal plane and（ 5. 9 ± 1. 7） ° in the sagittal plane in the ultrasound group,in comparison,（ 3. 5 ± 1. 1） ° and（ 4. 8 ± 1. 9） ° respectively in the fluoroscopy group.According to the criteria of pin placement,excellent and good pin placement was 92. 5% in the ultrasound group,by comparison,100% in the fluoroscopy group. However,there was no statistical difference between the two groups in anyone of the aforementioned parameters in reference to reduction and fixation of fracture（ P〈 0. 05）. [Conclusion]Under ultrasound monitoring,satisfactory reduction and fixation of femoral fracture with the external fixator could be achieved in this experimental model in the canine. It implies that portable ultrasonic system is effective and alternative to fluoroscopy,especially in rescuing the wounded with extremity fracture in the battlefield.