Eberhardt O, Zieger M, Wirth T, Fernandez F F
Orthopädische Klinik, Olgahospital Stuttgart.
Z Orthop Unfall. 2009 Nov-Dec;147(6):727-33. doi: 10.1055/s-0029-1185709. Epub 2009 Aug 28.
Determination of the femoral head position after closed or open reduction and application of a spica cast is possible by X-ray, MRI, CT or transinguinal ultrasound. In this study we compared the efficacy of transinguinal ultrasound and radiography. Further options with transinguinal ultrasound such as the determination of soft tissue and intraoperative possibilities are also described.
In a first cohort of 25 patients with 33 affected hips ultrasound and radiography were compared. In a second cohort of 8 patients with 11 affected hips ultrasound and arthrography were compared.
32 radiographs proved to be not useful for the precise determination of the femoral head position. In all ultrasound images the criteria described by van Douveren et al. could be identified. All ultrasound images in the study were useful and gave reliable information with regard to the femoral head position.
Consequently, standard radiographic documentation is no longer used as a standard in our clinic. MRI and CT are reserved for special cases. We recommend transinguinal ultrasound as a standard diagnostic method for determination of the femoral head position in hip spica casts. With a portable ultasound system, determination of the hip position using transinguinal ultrasound is immediately possible in the operating theatre.
通过X线、MRI、CT或经腹股沟超声可以确定闭合或切开复位及应用髋人字石膏固定后的股骨头位置。在本研究中，我们比较了经腹股沟超声和X线摄影的有效性。还描述了经腹股沟超声的其他用途，如软组织的测定及术中应用的可能性。
第一组纳入25例患者共33个患髋，比较超声和X线摄影。第二组纳入8例患者共11个患髋，比较超声和关节造影。
32张X线片被证明对精确确定股骨头位置无用。在所有超声图像中均可识别范杜韦伦等人描述的标准。本研究中的所有超声图像均有用，且能提供关于股骨头位置的可靠信息。
因此，在我们的诊所，标准的X线片记录不再作为标准使用。MRI和CT仅用于特殊情况。我们推荐经腹股沟超声作为确定髋人字石膏固定中股骨头位置的标准诊断方法。使用便携式超声系统，在手术室即可立即通过经腹股沟超声确定髋关节位置。
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