超声与C臂X线机引导闭合复位穿针固定治疗掌指骨骨折的疗效比较

Effectiveness comparison between ultrasound-guided and C-arm-guided in closed reduction and pinning for treatment of metacarpophalangeal fractures

目的对比超声与C臂X线机引导闭合复位穿针固定治疗掌指骨骨折的临床疗效。方法回顾分析2015年10月—2016年11月收治的30例掌指骨骨折患者临床资料,根据治疗方法分为超声组(采用超声引导下闭合复位穿针固定)和C臂X线机组(采用C臂X线机引导闭合复位穿针固定),每组15例。两组患者性别、年龄、病程、致伤原因、受伤指别、伤指部位、骨折分型等一般资料比较差异均无统计学意义(P>0.05),具有可比性。评价两组患者骨折复位情况及复位成功率(等级优、良、可者视为复位成功);记录手术时间、术中透视次数、骨折愈合时间;采用中华医学会手外科学会上肢部分功能评定试用标准评估手关节总活动度(total active movement,TAM)恢复情况。结果超声组手术时间多于C臂X线机组,术中透视次数少于C臂X线机组,比较差异均有统计学意义(P<0.05);超声组与C臂X线机组间复位等级及复位成功率比较,差异均无统计学意义(P>0.05)。两组患者均获随访,随访时间6~18个月,平均10个月。均未出现骨折畸形愈合、关节僵硬、肌腱粘连等并发症。两组骨折愈合时间及TAM等级和优良率比较差异均无统计学意义(P>0.05)。结论超声引导闭合复位穿针固定治疗掌指骨骨折效果良好,是一种可行的骨折闭合复位固定治疗辅助方法,且透视次数少,可减少手术放射损害。

Objective To compare the effectiveness between ultrasound-guided and C-arm-guided in closed reduction and pinning for the treatment of metacarpophalangeal fractures. Methods The clinical data of 30 patients with metacarpophalangeal fractures between October 2015 and November 2016 were retrospectively analyzed. According to different treatments, the patients were divided into ultrasound group （using ultrasound-guided closed reduction and pinning, n=15） and C-arm group （using C-arm-guided closed reduction and pinning, n=15）. There was no significant difference in gender, age, disease duration, causes of injury, injured finger, location of injury finger, fracture classification between 2 groups （P〉0.05）. The status and success rate of reduction were compared （excellent, good, and acceptable grades could be regarded as the successful reduction）. The operation time, intraoperative fluoroscopy times, and fracture healing time were recorded. And the postoperative functional recovery was evaluated according to the total active movement （TAM） by the standard functional evaluation issued by Hand Surgery Association of Chinese Medical Association. Results The operation time of ultrasound group was longer than C-arm group, and the intraoperative fluoroscopy times was less than C-arm group, all showing significant differences （P〈0.05）. There was no signifi cant difference in the grade and the success rate of reduction between 2 groups （P〉0.05）. All the patients were followed up 6-18 months （mean, 10 months）, without malunion, joint stiffness, tendon adhesions, and other complications. There was also no significant difference in the fracture healing time, the grade of TAM, and the excellent and good rate of TAM between 2 groups （P〉0.05）. Conclusion The treatment of ultrasound-guided closed reduction and pinning for metacarpophalangeal fractures is effective, which is a feasible auxiliary method of closed reduction and fixation for fracture. And less fluoroscopy can reduce the radiation damage of operation.