超声对股骨干骨折移位和复位及闭合复位髓内钉固定术的指导意义

Value of the ultrasonography in guiding closed reduction and intramedullary nail fixation for femoral shaft fractures

目的探讨股骨干骨折移位和复位后超声影像学特点及其对于指导闭合复位髓内钉固定的临床意义。方法观察21例股骨干骨折移位时的超声影像学特点；超声监视下予以闭合复位，观察骨折复位后的超声影像学特点，闭合复位后完成股骨干骨折的髓内钉固定术。结果股骨干骨折后在殷骨干长轴平面可见形成落差的两条不连续的强回声带（台阶征）；在股骨干横断面可见两条短弧形强回声带（双短弧征）。超声监视完成闭合复位后，可见台阶征和双短弧征消失，前方和后方都表现为两条连续性呈直线样的带状回声，并且前后方的直线平行（连续平行征），并能顺利插入髓内钉的导针，完成股骨干骨折的闭合复位髓内钉固定术。结论股骨干骨折移位后，超声具有台阶征、双短弧征等影像特点，骨折端复位后表现为连续平行征。超声观察骨折复位前后不同的影像学特征，对指导股骨干骨折的闭合复位髓内钉固定术有较高的临床应用价值。

Objective To study the ultrasonic image characteristics of the displaced femoral shaft fracture before and post reduction, and to explore its clinical significance in guiding the closed reduction and intramedullary nail fixation. Methods Ultrasonic imaging features of 21 cases of femoral shaft fractures were observed. Closed reduction was completed under ultrasound monitoring, and the characteristics of ultrasonic imaging after fracture reduction were observed. Fixation of femoral fractures with intramedullary nails after closed reduction was completed. Results On the long axis of the femoral shaft, the ultrasonograms displayed a gap between two hyperechoic bands（step sign）. On the cross section, two short arc hyperechoic bands can be seen（double short arc sign）. After the completion of closed reduction, the step sign and double short arc sign disappeared. In the front and rear of the femoral shaft, there were 2 echo lines connected to a straight line. The line in front of the femoral parallel to the rear（continuous parallel sign）. Continuous parallel sign indicated that reduction was achieved, the intramedullary nail guide pin could be successfully inserted into the femoral shaft, to complete the intramedullary nail fixation. Conclusions Ultrasound imaging shows step sign and double short arc syndrome when femoral shaft fracture displaced. Post fracture reduction, the imaging shows continuous parallel sign. Observing ultrasonic image characteristics of the displaced femoral shaft fracture is effective in assisting closed reduction and intramedullary nailing for femoral shaft fractures.