儿童跟骨骨折超声引导闭合复位经皮克氏针固定

Ultrasound-guided closed reduction and percutaneous Kirschner wire fixation for calcaneal fractures in children

摘要:

[目的] 探究超声引导闭合复位经皮克氏针固定儿童跟骨骨折的临床疗效。[方法] 回顾性分析本院 2020 年 1 月— 2022 年 8 月收治的 100 例跟骨骨折患儿的临床资料，均接受闭合撬拨复位克氏针内固定治疗，根据医患沟通结果，超声引导下操作 55 例 （超声组），透视下操作 45 例 （透视组）。对比两组患儿围手术期、随访及影像资料。[结果] 超声组手术时间 [(35.0±6.8) min vs (58.2±10.4) min, P＜0.001]、影像检查时间 [(325.0±25.6) s vs (600.5±73.5) s, P＜0.001]、术中透视次数 [(2.7±0.8) 次 vs (10.2±2.8) 次, P＜0.001]、下地行走时间 [(3.0±0.5) d vs (3.5±1.0) d, P=0.002] 及住院时间 [(4.5±1.6) d vs (5.4±2.0) d, P=0.014] 均显著优于透视组。与术后 1 个月相比，末次随访时两组 VAS 评分、AOFAS 评分、踝背伸-跖屈及内-外翻 ROM 均显著改善 （P＜ 0.05）；术后 1 个月，超声组 VAS 评分显著优于透视组 [(2.0±0.6) vs (2.3±0.7), P=0.023]，其他相应时间点，两组间上述指标的差异均无统计学意义 （P＞0.05）。影像方面，随时间推移，两组 Bohler 角、Gissane 角、关节软骨塌陷高度均显著改善 （P＜ 0.05）。术后 1 个月超声组关节软骨塌陷高度 [(2.0±0.7) mm vs (2.5±0.6) mm, P＜0.001] 显著小于透视组，相应时间点，两组间其他影像指标的差异均无统计学意义（P＞0.05）。[结论]超声引导闭合复位内固定治疗儿童跟骨骨折疗效较好，相比透视下操作具有手术时间短、辐射损伤小、术中出血量少的优点。

Abstract:

[Objective] To explore the clinical efficacy of ultrasound-guided closed reduction and percutaneous Kirschner wire fixation for calcaneal fractures in children. [Methods] A retrospective study was conducted on 100 children admitted into our hospital for calcaneal fractures from January 2020 to August 2022. All of them received closed prying reduction and percutaneous Kirschner wire fixation. According to preoperative doctor-patient communication, 55 cases had operation performed under ultrasound guidance (ultrasound group), while other 45 cases were under fluoroscopy (fluoroscopy group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] The ultrasound group proved significantly superior to the fluoroscopy group in terms of operation time [(35.0±6.8) min vs (58.2±10.4) min, P＜0.001] and imaging check time [(325.0±25.6) s vs (600.5±73.5) s, P＜0.001], intraoperative fluoroscopy times [(2.7±0.8) times vs (10.2±2.8) times, P＜0.001], walk time [(3.0±0.5) days vs (3.5±1.0) days, P=0.002] and hospital stay [(4.5±1.6) days vs (5.4±2.0) days, P=0.014]. Compared with those 1 month after surgery, the VAS score, AOFAS score, ankle dorsal-plantar flexion and inversion-eversion range of motions (ROMs) significantly improved in both groups at the last follow-up (P＜0.05). One month after surgery, the VAS score in the ultrasound group was significantly better than that in the fluoroscopy group [(2.0±0.6) vs (2.3±0.7), P=0.023], whereas at other corresponding time points, there was no statistical significance in the above indexes between the two groups (P＞0.05). Regarding imaging, the Bohler's angle, Gissane's angle and articular cartilage collapse height were significantly improved over time in both groups (P＜0.05). The articular cartilage collapse height in the ultrasound group was significantly lower than that in the fluoroscopy group one month after surgery [(2.0±0.7) mm vs (2.5±0.6) mm, P＜0.001], regardless of no statistically significant differences in other imaging indicators between the two groups at any corresponding time points (P＞0.05). [Conclusion] Ultrasound-guided closed reduction and percutaneous Kirschner wire fixation has the advantages of shorter operation time, less radiation damage and less intraoperative bleeding over the fluoroscopy-guided counterpart for calcaneal fractures in children.