【摘要】 目的 探讨肌骨超声联合多层螺旋CT(MSCT)三维重建定位法在肋骨骨折内固定术中的应用价值。方法 回顾性分析2022年1月—2023年12月蚌埠医科大学附属蚌埠第三人民医院接受肋骨骨折内固定术的60例患者资料，其中男性44例，女性16例；年龄35～69岁，平均54.7岁；摔伤34例，道路交通伤21例，高处坠落伤5例。根据肋骨骨折断端定位方法不同分为实验组(30例)与对照组(30例)。实验组首先通过MSCT三维重建初步确定错位最明显的骨折位置，经肌骨超声检查确认并标记，然后根据MSCT显示的骨折断端周围关系，再次用肌骨超声检查确认标记剩余骨折断端。对照组采取MSCT三维重建结合手法触诊的传统定位法。对比分析两组患者骨折断端定位准确率、单处骨折断端定位时间、单处骨折断端切口长度、单处骨折断端手术暴露时间及术后48 h数字评分量表(NRS)疼痛评分。结果 实验组手术固定骨折肋骨117根共127处，其中准确定位120处，定位准确率94.5%。对照组手术固定骨折肋骨95根共106处，其中准确定位82处，定位准确率77.4%。两组定位准确率比较差异有统计学意义(P<0.05)。实验组单处骨折断端定位时间[(38.60±3.47)svs.(46.97±3.88)s]、单处骨折断端切口长度[(1.96±0.57)cm vs.(2.80±0.90)cm]、单处骨折断端手术暴露时间[(4.83±1.12)min vs.(7.17±1.07)min]、术后48 h NRS疼痛评分[(2.93±1.08)分vs.(3.87±1.11)分]均优于对照组(P<0.01)。结论 肌骨超声联合MSCT三维重建用于肋骨骨折断端定位，可显著提升定位速度和准确率，缩短手术切口，加速骨折断端手术暴露，并有效缓解术后疼痛。更多还原

【Abstract】 Objective To explore the application value of musculoskeletal ultrasound combined with multislice CT(MSCT) 3D reconstruction in positioning the rib fracture ends during fixation surgery. Methods A retrospective analysis was conducted on patients who underwent internal fixation surgery for rib fractures at the Third People’s Hospital of Bengbu Medical University from Jan. 2022 to Dec. 2023. A total of 60 patients were enrolled, with 44 males and 16 females aged 35-69(mean 54.7) years. The causes of injury were falls in 34 cases, road traffic accidents in 21,and falls from height in 5. Patients were allocated into two groups based on the method of rib fracture end positioning: the experimental group and the control group(n=30 for each). In the experimental group, MSCT 3D reconstruction was first used to locate the most obvious fractures, which were then confirmed and marked by musculoskeletal ultrasound; thereafter musculoskeletal ultrasound was re-conducted to locate the rest fracture ends based on the surrounding relations present on MSCT images. In the control group, the traditional MSCT 3D reconstruction and palpation were adopted for positioning. The accuracy of fracture end positioning, positioning time, incision length and surgery exposure time of a single fracture end, as well as NRS scores for pain 48 h postoperatively, were recorded and compared between the two groups. Results The experimental group fixed 117 rib fractures with 127 ends, of which 120 were accurately positioned, with an accuracy rate of 94.5%. The control group fixed 95 rib fractures with 106 ends, of which 82 were accurately positioned, with an accuracy rate of 77.4%. Statistically significant difference was observed in the accuracy of fracture end positioning between the two groups(P<0.05). Compared with the control groups, the experimental group showed much shorter positioning time(s, 38.60±3.47 vs. 46.97±3.88),incision length(cm, 1.96±0.57 vs. 2.80±0.90) and surgery exposure time(min, 4.83±1.12 vs. 7.17±1.07) for a single fracture end, and the NRS score 48 h postoperatively were much lower(2.93±1.08 vs. 3.87±1.11),with statistically significant differences(all P<0.01). Conclusion The combined use of musculoskeletal ultrasound and MSCT 3D reconstruction for rib fracture end positioning can significantly improve speed and accuracy, reduce surgical incision length, facilitate fracture end exposure during surgery, and effectively alleviate postoperative pain.更多还原