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超声引导下经皮撬拨复位克氏针内固定治疗低龄儿童跟骨关节内骨折
Ultrasound-guided percutaneous reduction by leverage and pin internal fixation for calcaneal intraarticular fracture in young children
  
DOI:
中文关键词:  超声  低龄儿童  跟骨骨折  撬拨复位  辐射损伤
英文关键词:Ultrasound  Young children  Calcaneal fracture  Reduction by leverage  Radiation damage
基金项目:
作者单位
卢宜哲 洪庆南 郑耿阳 柯清辉  
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中文摘要:
      目的 探讨超声引导下经皮撬拨复位克氏针内固定治疗低龄儿童跟骨关节内骨折的临床效果。方法 自2012年6月至2020年1月,中国人民解放军联勤保障部队第910医院小儿骨科共收治低龄儿童跟骨关节内骨折21例。其中,男17例,女4例;年龄3 ~ 7岁,平均(4.85±1.46)岁。受伤至手术时间3 ~ 48 h,平均(23.05±13.14)h。骨折Sanders分型:Ⅱ型16例,Ⅲ型5例。术前跟骨Böhler角7.1° ~ 11.7°,平均(9.44±1.53)°;术前跟骨Gissane角153° ~ 170°,平均(160.62±5.26)°。所有患者均采用克氏针撬拨复位内固定治疗,根据术中引导方式分为:超声组11例,采用术中超声引导下跟骨闭合复位;透视组10例,采用术中透视下跟骨闭合复位。记录手术时间、术中出血量、X线透视次数、VAS评分和AOFAS评分,测量跟骨Böhler角和Gissane角及关节软骨塌陷高度。结果 超声组手术时间和透视次数均少于透视组(P<0.01),而出血量与透视组相似(P>0.05)。超声组的术后Böhler角、Gissane角、VAS评分和AOFAS评分与透视组比较,差异无统计学意义(P>0.05)。超声组的关节软骨塌陷高度为(1.91±1.14) mm,透视组为(2.90±1.45) mm,两组间比较差异有统计学意义(t=2.353,P<0.05)。结论 超声引导下经皮撬拨复位内固定,应用在低龄儿童跟骨关节内骨折具有辐射损伤小、手术时间短、复位效果满意的优点,可以作为该骨折类型的可选手术方式之一。
英文摘要:
      Objective To evaluate the effect of ultrasound-guided percutaneous reduction by leverage and pin internal fixation for calcaneal intraarticular fracture in young children. Methods Between June 2012 and January 2020, there were 21 children were treated in the Department of Orthopedics, the 910th Hospital of Chinese PLA. There were 17 males and 4 females. The average age was (4.85±1.46) years [range 3 to 7 years]. The average time from trauma to surgery was (23.05±13.14) h [range 3-48 h]. According to Sanders fracture classification, there were 16 cases in typeⅡ, and 5 cases in type Ⅲ. The average preoperative Böhler angle was (9.44±1.53)°[range 7.1° to 11.7°], and Gissane angle was (160.62±5.26)°[range 153° to 170°]. All children were underwent percutaneous reduction by leverage and pin internal fixation. According to type of guidance, 11 children in ultrasound group were ultrasound-guided and 10 children in X-ray group were X-ray guided.The time of operation, loss of bleeding, number of X-ray, VAS score, AOFAS score, Böhler angle, Gissane angle and compression height of articular surface were recorded. Results Time of operation and number of X-ray in ultrasound group were less than X-ray group(P<0.01), but there was no significant difference about loss of bleeding between two groups(P>0.05). There was no significant difference between two group about postoperative Böhler angle, Gissane angle, VAS score and AOFAS score(P>0.05). The compression height of articular surface in ultrasound group was (1.91±1.14) mm, and (2.90±1.45) mm in X-ray group, and there was significant difference between two groups(t=2.353,P<0.05). Conclusion Ultrasound-guided percutaneous reduction by leverage and pin internal fixation for calcaneal intraarticular fracture in young children, has advantages of low radiation damage, short time of operation and good reduction, and it could be an optional surgery method.
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