超声引导下闭合复位穿针固定治疗成人指骨骨折

Ultrasound guided closed reduction and pinning for adult phalangeal fractures

目的评估超声在成人指骨骨折治疗中的应用价值，分析超声辅助治疗成人指骨骨折的优缺点及效果。 方法选取我院收治随访的20例成人指骨骨折患者（23指），指骨干骨折14指，指骨基底部骨折6指，指骨髁部骨折3指，均采用术前超声及X线分析，术中超声辅助复位，同时超声引导克氏针闭合穿针固定，记录术中出血量、术中透视次数。随访术后X光片、手指总主动活动度（TAM）及握力。结果术后随访时间6～24个月，平均16个月，超声引导下骨折复位成功17指，6指行C臂下透视复位。骨折平均愈合时间为（6.21±2.10）周。14指TAM评分为优（60.9%），5指为良（21.7%），4指为中或差（17.3%），优良率82.7%。患侧握力（32.5±7.8）kg，健侧握力（34.5±9.9）kg，双侧比较差异无统计学意义（t＝0.351，P＝0.726）。无骨折不愈合发生。结论超声引导下闭合复位穿针固定指骨骨折，能观察术中对位，明显减少X线辐射，且创伤小、失血少，但对某些类型骨折，如指骨基底部及髁部粉碎性骨折，其效果尚待进一步研究。

Objective To evaluate the value of ultrasound in adults phalangeal fractures, analysze clinical efficacy of ultrasound-assisted closed reduction and pinned fixation of adult phalangeal fracture. Methods A total of 23 phalanx fractures in 20 adult cases were recruited, including shaft fractures 4 fingers, the bottom fracture 13 fingers, and condylar fracture 6 fingers. All cases were examined by preoperative ultrasound and X-ray, intraoperative ultrasound assisted reset, and ultrasound-guided closed reduction were performed. Clinical evaluation included operative time, blooding, fluoroscopy times, the success rate of reduction inoperative, postoperative x-rays, total active motion （TAM） and grip strength. Results The postoperative follow-up ranged from 6 to 24 months, with an average of 16 months. Seventeen fingers were successful by ultrasound-guided closed reduction, and 6 fingers was reduced by C arm fluoroscopy. The average healing time was （6.21± 2.10） weeks. According to the functional evaluation criteria based on TAM, the results were rated as excellent in 14 cases （60.9%）, good in 5 cases （21.7%）, fair and poor in 4 cases（17.3% ）, the total excellent and good rates was 82.7%. Grip strength was （32.5 ± 7.8）kg in affected side and （34.5 ± 9.9）kg in opposite side, there was no significant difference（ t = 0.351, P = 0. 726）. No nonunion occurred. Conclusions The position can be observed by ultrasound-guided pereutaneous pinning of phalangeal fractures. It＇s advantages are the less trauma, less blooding, and less X ray exposure. But for some types of fractures, such as the bottom fracture and condylar fracture, the effects should be further studied.