高频超声引导下造影定位在肋骨骨折内固定术中的应用

The application of contrast-enhanced location guided by high frequency ultrasound in internal fixation for rib fracture

目的探究肋骨骨折内固定术前在高频超声引导下局部注射美兰对于骨折定位的价值。方法收集因肋骨骨折住院治疗的85例患者资料,分为治疗组40例和对照组45例,治疗组术前采用高频超声引导局部注射稀释美兰,对照组常规采用CT三维重建引导定位。观察两组患者定位准确率、切口长度、手术时间、手术出血量、切口愈合时间、引流量、拔管时间、白细胞是否升高、是否发热、疼痛评分、CGI评分等指标。结果治疗组切口长度、骨折愈合时间、留管时间、引流量、手术时间、手术出血量、疼痛评分(VAS)与对照组比较,差异有统计学意义(P<0.05);治疗组切口准确率、切口愈合时间、白细胞升高与对照组比较,差异无统计学意义(P>0.05)。治疗组严重程度评分、疗效总评及疗效指数好转率较对照组增高,差异均有统计学意义(P<0.05)。结论高频超声引导下造影定位对于复位内固定手术切口设计显著正向引导作用,减轻患者痛苦及住院时间,造影剂的注射未增加术后伤口感染及骨折愈合阻碍作用。

Objective To investigate the value of local injection of methylene blue under the guidance of high frequency ultrasound for fracture location before rib fracture internal fixation.Methods The 85 cases with rib fracture from January 2015 to January 2019 were collected and divided into treatment group(40 cases)and control group(45 cases).High frequency ultrasound was applied to guide local injection of melanin before operation in treatment group.The control group received routinely guided by CT three-dimensional reconstruction.The location accuracy,incision length,operation time,bleeding volume,incision healing time,average drainage volume,average extubation time,leukocyte elevation,fever,pain score and CGI score were observed.Results The incision length,fracture healing time,indwelling time,drainage volume,operation time,bleeding volume and pain score(VAS)of the treatment group were significantly different from those of the control group(P≤0.05).There was no significant difference in incision accuracy,incision healing time,incision infection cases,leucocyte elevation and fever between the treatment group and the control group(P>0.05).The improvement rate of severity score,total curative effect evaluation and curative effect index in the treatment group were significantly higher than those in the control group(P<0.05).Conclusion The contrast localization guided by high-frequency ultrasound has a significant positive guiding effect on the design of incision for reduction and internal fixation,relieving patients′pain and hospital stay.Injection of contrast agent does not increase wound infection and hinder fracture healing after operation.