超声全程动态监测下鼻骨骨折闭合性复位的可视化研究

Visualization of closed reduction of fresh nasal bone fractures under whole-course dynamic ultrasound monitoring

目的评估超声全程动态监测在成人鼻骨骨折治疗中的应用价值,分析全程超声动态监测下实行手法整复治疗成人鼻骨骨折的可行性及效果。方法选取我院收治随访的92例成人鼻骨骨折患者,按随机化原则分为试验组和对照组两组,试验组采取全程超声动态监测的方法进行鼻骨骨折闭合性复位,对照组采取传统鼻骨骨折闭合性整复方法进行复位。分别从术前时间、术中操作时间、住院时间、二次调整率、CT扫描次数及术后CT评分、鼻外形、鼻通气等方面对二者的疗效进行评价。结果试验组46例患者均在满足全身麻醉条件下立即行手法整复治疗,术中复位器对位准确、填塞物填塞稳妥,住院时间短,术后调整率为零。术后CT评分、鼻通气及鼻外形情况均优于对照组。结论改变站位后的全程超声动态监测下新鲜鼻骨骨折闭合复位,能提前手法整复时间,透过超声探头全程监测复位器与骨折块位置情况、复位器撬拨作用下骨折端移动情况、填塞物填塞情况、填塞物作用下骨折块移动情况,使鼻骨骨折闭合性复位由盲视变为可视,缩短治疗时间,提高复位准确率及CT满意度,使临床深入总结鼻骨骨折类型及各型骨折复位方法成为可能。

Objective To evaluate the application value of whole-course dynamic monitoring of ultrasound in the treatment of adult nasal bone fracture,and to analyze the feasibility and effect of manual reduction under the whole-course dynamic monitoring of ultrasound in the treatment of adult nasal bone fracture.Methods Ninety-two adult patients with nasal bone fracture were divided into experimental group and control group according to the principle of randomization.The experimental group was treated with closed reduction of nasal bone fracture by whole-course ultrasound dynamic monitoring,while the control group was treated with traditional closed reduction of nasal bone fracture.The curative effects of the two methods were evaluated in terms of preoperative time,intraoperative operation time,hospital stay,secondary adjustment rate,number of CT scans and post-operative CT scores,nasal shape and nasal ventilation.Results The 46 patients in the experimental group were treated with manual reduction immediately under general anesthesia.The reduction device was positioned accurately during the operation,the filling was stable,the hospitalization time was short,and the adjustment rate was zero after the operation.Postoperative CT scores,nasal ventilation and nasal contour were better than those of the control group.Conclusion Closed reduction of fresh nasal bone fracture under dynamic monitoring of whole course ultrasound after changing the position can advance the time of manual reduction,monitor the position of reduction device and fracture block,the movement of fracture end under the prying action of reduction device,the packing condition and the movement of fracture block under the action of packing material through the ultrasonic probe,which can make closed reduction of nasal bone fracture from blindness to visualization and shorten the treatment.It is possible to summarize the types and reduction methods of nasal bone fracture in clinic by improving the accuracy of reduction and the satisfaction of CT.