CAJ | 학술논문

目的应用超声判断股骨干中段骨折闭合复位髓内钉固定术后股骨的旋转状态并测量股骨的旋转畸形角度,探讨本测量方法的精确性. 方法本研究对象为2012年1月至2013年1月采用闭合复位髓内钉固定的20例成年股骨干中段骨折患者,男12例,女8例;年龄为18 ～52岁,平均30.5岁.所有患者均为单侧闭合性骨折.骨折按照AO/ASIF分型:32A2型8例,32B1型4例,32B2型3例,32C2型5例.超声检查时间为髓内钉固定术后5～7d(平均5.7 d).术后患者取俯卧位,应用超声观测股骨粗线:分别在骨折远、近端观测股骨短轴,股骨粗线在显示器上表现为尖状强回声影;利用此影像特点,调整超声探头角度,并应用直径为60 cm的弧形量角器测量股骨的旋转畸形角度.然后通过CT测量股骨旋转畸形角度来验证超声测量方法的精确性. 结果 20例患者术后患肢应用超声测量的股骨旋转畸形角度平均为5.82°±3.38°,应用CT测量的股骨旋转畸形角度平均为6.00°±3.72°,差值平均为-0.19°±1.02°,二者比较差异无统计学意义(t=0.808,P=0.429).超声测量结果显示:骨折远端外旋畸形14例,内旋畸形5例,无旋转畸形1例.超声测量与CT测量的结果、旋转方向完全一致. 结论超声观测患肢股骨粗线能准确地判断股骨干中段骨折闭合复位髓内钉固定术后股骨的旋转状态,并精确地测量出股骨的旋转畸形角度.
목적 응용초성판단고골간중단골절폐합복위수내정고정술후고골적선전상태병측량고골적선전기형각도,탐토본측량방법적정학성. 방법 본연구대상위2012년1월지2013년1월채용폐합복위수내정고정적20례성년고골간중단골절환자,남12례,녀8례;년령위18 ～52세,평균30.5세.소유환자균위단측폐합성골절.골절안조AO/ASIF분형:32A2형8례,32B1형4례,32B2형3례,32C2형5례.초성검사시간위수내정고정술후5～7d(평균5.7 d).술후환자취부와위,응용초성관측고골조선:분별재골절원、근단관측고골단축,고골조선재현시기상표현위첨상강회성영;이용차영상특점,조정초성탐두각도,병응용직경위60 cm적호형량각기측량고골적선전기형각도.연후통과CT측량고골선전기형각도래험증초성측량방법적정학성. 결과 20례환자술후환지응용초성측량적고골선전기형각도평균위5.82°±3.38°,응용CT측량적고골선전기형각도평균위6.00°±3.72°,차치평균위-0.19°±1.02°,이자비교차이무통계학의의(t=0.808,P=0.429).초성측량결과현시:골절원단외선기형14례,내선기형5례,무선전기형1례.초성측량여CT측량적결과、선전방향완전일치. 결론 초성관측환지고골조선능준학지판단고골간중단골절폐합복위수내정고정술후고골적선전상태,병정학지측량출고골적선전기형각도.
Objective To assess the feasibility and accuracy of the ultrasound evaluation of femoral rotational deformity following closed reduction and intramedullary nailing for fracture of middle femoral shaft.Methods Enrolled in this study were 20 adult patients with fracture of middle femoral shaft who had been treated with closed reduction and intramedullary nailing from January 2012 to January 2013 in our department.They were 12 men and 8 women,aged from 18 to 52 years (average,30.5 years).All the cases were unilateral closed fractures.According to the AO/ASIF classification,8 cases were 32A2,4 cases 32B1,3 cases 32B2,and 5 cases 32C2.Ultrasound examinations were conducted 5 to 7 days postoperation (average,5.7 days).The femoral thick line was observed with the patients in prone position.Next,the minor axis of femoral shaft was observed at both the proximal and distal ends of the fracture.Based on the tip-shaped strong echo images of the femoral thick line on the screen,the angle of ultrasound probe was adjusted to measure the rotational angle of the femoral deformity using an arc angle gauge,60 cm in diameter.The accuracy of ultrasound evaluation was verified by comparing the angles measured by ultrasound examination and by CT scanning.Results The ultrasonic measurement revealed that the average angle of the femoral rotational deformity after operation was 5.82° ± 3.38° in the 20 patients.The CT measurement showed that the average angle of the femoral rotational deformity was 6.00° ± 3.72°.There was no statistically significant difference between the 2 measurements (t =0.808,P =0.429).According to the ultrasonic measurement,14 cases had deformity of distal external rotation,5 deformity of internal rotation,and one was free of rotational deformity,showing a complete agreement with the results of CT measurement.Conclusion Ultrasound evaluation of the femoral thick line at the affected side can accurately detect the rotational condition of the femurs and accurately measure the angle of rotation deformity following closed reduction and iedullary nailing for fracture of middle femoral shaft.