肌肉骨骼超声在长管状骨骨折骨不连冲击波治疗中的应用价值

目的探讨肌骨超声在长管状骨骨折骨不连体外冲击波治疗（ESWT）中的应用价值。 方法选取2017年10月至2019年3月因长管状骨骨折诊断骨不连拟接受ESWT的患者共41例，45处骨折不愈合部位，所有患者均在ESWT前超声评估骨折间隙，断端有无软组织嵌顿及异物，断端附近血流情况，标记拟治疗区域的断端、大血管、神经及固定物在体表投影；ESWT后每隔2个月复查超声，评估治疗处骨折间隙，骨折间隙回声是否增高，断端附近血流情况，同时复查正侧位X线平片，评估断端愈合情况。 结果1例胫骨骨折患者发现拇长伸肌腱嵌顿转为手术治疗，所有肌骨超声定位ESWT患者均未发生神经血管并发症，5例患者ESWT后断端附近血流明显增多，24例患者临床查体及X线诊断骨折愈合，超声显示6例患者骨折线愈合，28例骨折间隙小于2 mm，18例骨折间隙回声增高，以骨折间隙小于2.1 mm且回声增高或骨折线消失为诊断骨折愈合的标准，超声诊断骨折愈合的准确性95.5%，敏感度91.7%，特异度100.0%。 结论肌肉骨骼超声可以作为ESWT术前评估适应症，术中定位，术后检测治疗效果的有效方法。

Value of musculoskeletal ultrasound in shock wave therapy of long tubular bone fracture nonunions

ObjectiveTo assess the value of musculoskeletal ultrasound in extracorporeal shock wave therapy (ESWT) of long tubular bone fracture nonunions. MethodsA total of 41 patients with 45 fracture nonunions were enrolled. Fracture gap distance, soft tissue incarceration, foreign body in the gap, and blood flow near the fracture gap were assessed by ultrasound before ESWT. Fracture gap, large blood vessels, nerves, and fixations on the body surface were marked. After ESWT, ultrasonic examination was performed every two months for detecting the distance of nonunion gap, echogenicity of the gap, and blood flow near the fracture gap. Anteroposterior and lateral projection X-ray films were used to assess the healing of the fractures. ResultsOne patient with tibia fracture accepted surgical operation for incarceration of the extensor digitorum longus. No neurovascular complication was found in the patients treated with musculoskeletal ultrasound-guided ESWT. Significantly increased blood flow near the fracture gap was found in five patients, and 24 patients were diagnosed with fracture healing according to clinical and X-ray examinations. Ultrasonography showed fracture line healing in six cases, fractured gap less than 2 mm in 28 cases, and hyperechoic fractured gap in 22 cases. Using fracture gap less than 2.1 mm with hyperechogenicity or fracture line disappearance as the ultrasonic criteria of diagnosing fracture healing, the accuracy, sensitivity, and specificity were 95.5%, 91.7%, and 100.0%, respectively. ConclusionMusculoskeletal ultrasound may be used as an effective method for preoperative evaluation of indications of ESWT, intraoperative localization, and postoperative evaluation of therapeutic effects.