儿童肱骨髁上骨折整复后摄影体位对整复效果评估的探讨

Modified X-ray photography position for the reduction evaluation in pediatric humerus condyle fracture

目的探讨儿童肱骨髁上骨折整复后摄影体位的改进对判断整复效果的影响。方法收集2016年10月~2017年3月于我科进行X射线摄影的儿童肱骨髁上骨折患儿60例,均为长臂石膏托固定曲肘。其中闭合整复无克氏针固定30例;克氏针固定30例。按照改良体位进行摄影。采用既往方法摄影的患儿作为对照组,无克氏针固定30例,克氏针固定30例。既往方法组摄影时患儿仰卧,以患侧肘关节支撑检查床,使患侧肱骨长轴与检查床倾斜,X射线中心线经肘关节中点射入,垂直于影像接收器;改良方法组摄影时患儿仰卧,使肱骨长轴与检查床平行,X射线中心线经肱骨远端垂直射入影像接收器。对两组图像进行质量评价,采用卡方检验及Fisher精准检验对其标准片率进行统计学分析。结果改良方法所得影像能清晰显示肱骨远端的解剖结构,肱骨内外髁轮廓对称,影像无变形,密度对比度良好。既往方法所得影像存在肱骨远端变形等问题。改良方法图像达标率明显高于既往方法(P<0.001)。结论改良方法简便可靠,图像质量明显优于既往方法,可更加准确地观察整复效果并评估预后功能。

Objective To explore the effect of the modified X-ray photography method in reduction evaluation in pediatric humerus condyle fracture. Methods 60 patients were enrolled from October 2016 to March 2017 in our institution. Two groups were devided by repairing methods. Group 1 （ n = 30 ） without Kuntscher pin fixation ： Group 2 （ n = 30） with Kuntscher pin fixation. Those 60 patients underwent modified X-ray photography method. The operation methods were as follow： supine, make the humerus long axis parallel to the table, made the center line of the X-ray was vertically to the receiver. The conventional method was also taken in 60 patients with supine position, placed olecroanon against to the table, make the long axis of the humerus and forearm lean to the table. Namely, the humerus and forearm were symmetric. And the X-ray center line of the elbow entered into the midpoint and perpendicular to the receiver. All the cases were analyzed by chisquare and Fisher＇ s test. Results Modified methods showed clear anatomical structures of the humerus and humerus condyle. And the contour was symmetry without distor- tion. Conventional method, by contrast, showed the distal humerus with deformation and distortion. Modified method improved significantly （ P 〈 0. 001 ） image quality. Conclusion Modified method was much more simple and reliable than the conventional method, and more accurate to observe and evaluate the reduction effect and prognosis