桡骨远端骨折超声治疗效果的定量CT评价

目的 观察定量CT评价低强度超声仪(LIUS)促进桡骨远端骨折愈合效果和应用价值.方法 选取20例闭合性桡骨远端A型骨折患者为研究对象,随机分为超声组(10例,骨折手法复位、石膏外固定后给予超声治疗)和对照组(10例,单纯骨折手法复位、石膏外固定).超声组每天治疗1次,每次20 min,超声平均强度为30 mW/cm2;所有患者均在第14,42,70天采用TOSHIBA CT机Aquilion、TSX-101A,标准骨密度(BMD)体模及扫描条件为120 kV,75 mAs,0.5 s,层厚5 mm)扫描骨折端远近3 cm骨段和体模,测量两侧骨骼的皮质横截面积(CSA)和皮质骨骨密度(cBMD),观察及计算两组以骨折端为中心远近1 cm(共计5个层面)骨段的力学强度指数(BSICSA=CSA×cBMD)、骨折端X线表现、骨折愈合时间等相关指标并予统计学分析.结果 超声组与对照组相比,骨折端BSI F组别值为18.823,BMD F组别值为3.085.差异均有统计学意义(P<0.05或0.01).定量CT所获取数值显示超声干预和时间因素的交互作用最有效,超声干预作用次之(Eta组别*时阃>Eta组别>Eta时间).结论 LIUS可促进桡骨远端骨折愈合,其中定量CT所提供的CSA和cBMD能够作为桡骨远端骨折愈合的定量评价依据,且比传统方法更精确、更具体、更灵敏.

Quantitative computed tomography for assessment of therapeutic efficacy of low-intensity ultrasound on distal radius fracture repair

Objective To observe the potential of quantitative CT (QCT) in assessment of ther- apeutic efficacy of low-intensity ultrasound (LIUS) on repair of distal radius fracture. Methods A total of 20 patients with distal radius fractures (type A) were randomly divided into ultrasound group (10 cases, treated with ultrasound therapy after manipulative reduction and cast immobilization) and control group (10 cases, treated only with manipulative reduction and cast immobilization). Ultrasound group re- ceived ultrasound treatment for 20 minutes per day, with average ultrasound intensity of 30 mW/cm2. All patients were followed up weekly by three specified orthopedic surgeons for a period of 4-7 months (aver- age 5.4 months). Fracture union time, cortical cross sectional area (CSA) and cortical bone mineral density (BMD) were detected by QCT (TOSHIBA Aquilion/TSX-101A, with the original standard bone density scanning phantom and a condition of 120 kV, 75 mAs, 0.5 s and 5 mm slice thickness) at days 14, 42 and 70. After bone mass of 3 cm ranging around the fracture site and standard phantom scanned, CSA and BMD of both sides were measured, the average bone strength index (BSI) (cortical CSA x corti- cal BMD) in 1 cm around fracture site (5 slices), X-ray manifestation of fracture site and fracture heal- ing time were calculated and statistically analyzed. Results Compared with the control group, the ul- trasound group had higher BSI (Fgroup = 18. 823, P < 0. 01) and cortical BMD (Fgrop = 3. 085, P < 0.05). The interaction between LIUS and time factor was Etagrop*time. Etagrop Etatime Conclusions LIUPS can effectively accelerate the fracture healing process. CSA and BMD at the fracture site assessed by QCT may serve as quantitative indices in evaluation of distal radius fracture healing, showing the potential diagnostic superiority in precision, substantivity and sensitivity compared with conventional methods.