术前影像学测量在胫骨髓内钉治疗中的应用-现代医学

术前影像学测量在胫骨髓内钉治疗中的应用

单位：滁州市第一人民医院, 安徽滁州 239000

分类号：R683.42

出版年·卷·期（页码）：2022·50·第六期（717-721）

摘要：

目的：探究术前影像学测量在胫骨髓内钉中的应用。方法：回顾性收集2017年3月至2020年12月于本院接受髓内钉治疗的胫骨干骨折患者66例，随机分为X线组、CT组，两组术前分别通过X线、CT测量健侧胫骨的髓腔长度及狭窄部直径以预测髓内钉型号，比较两组间术前髓内钉预测值及术中所用的髓内钉实际值；观察两组术中出血量、透视次数、手术时间以及扩髓次数；术后随访6个月,观察比较两组膝关节功能评分(Lysholm评分)、疼痛视觉模拟评分(VAS评分)以及胫骨骨折愈合评分(RUST评分)。结果：X线组术前髓内钉长度及直径预测值大于术中所用的髓内钉长度及直径实际值，且预测值与实际值之间的差值大于CT组，差异有统计学意义(P＜0.05)；X线组术中出血透视次数、扩髓次数多于CT组，差异有统计学意义(P＜0.05)；X线组术后6个月膝关节疼痛VAS评分大于CT组，差异有统计学意义(P＜0.05)。结论：胫骨髓内钉术前CT测量较X线测量更加精确，能够减少术中出血量、扩髓次数以及透视次数，减轻患者术后膝关节疼痛，对胫骨干骨折的髓内钉治疗具有一定的指导意义。

Objective: To explore the application of preoperative imaging measurement in tibial intramedullary treatment nail. Methods: A retrospective collection of 66 patients with tibial shaft fractures who received intramedullary nail treatment in our hospital from March 2017 to December 2020 were randomly divided into X-ray group and CT group. Before the operation, the length and the diameter of the stenosis of the contralateral tibia marrow cavity were measured by X-ray and CT respectively to predict the type of intramedullary nail. The predicted value of intramedullary nail before operation and the actual value of intramedullary nail used during the operation between the two groups were compared. The amount of intraoperative blood loss, the number of fluoroscopy, the operation time and the number of reaming in the two groups were observed. Following up for 6 months after operation, the knee joint function score(Lysholm score), visual analogue scale of pain score(VAS score) and tibial fracture healing score(RUST score) between the two groups were observed and compared. Results: The predicted value of the length and diameter of the intramedullary nail before the operation in the X-ray group was significantly greater than the actual value of the intramedullary nail used in the operation, and the difference between the predicted value and the actual value was significantly greater than that of the CT group(P<0.05). The intraoperative blood loss, the number of fluoroscopy, and the number of reaming in the X-ray group were significantly more than those in the CT group(P<0.05).The VAS score of knee joint pain in the X-ray group was significantly greater than that of the CT group at 6 months after surgery(P<0.05). Conclusion: Preoperative CT measurement of tibial intramedullary nail is more accurate than X-ray measurement, which can reduce intraoperative blood loss, reaming times, fluoroscopy times, and postoperative knee pain in patients. Preoperative CT measurement of tibial intramedullary nail can also provide certain guidance for intramedullary nail treatment of tibial shaft fractures.

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