Saengsin Jirawat, Vaseenon Tanawat, Pattamapaspong Nuttaya, Kritsaneephaiboon Apipop
Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Injury. 2017 Aug;48(8):1758-1763. doi: 10.1016/j.injury.2017.07.002. Epub 2017 Jul 5.
A minimal invasive plate osteosynthesis (MIPO) has an advantage of biological soft tissue preservation that consists of preserving bony blood supply, fracture hematoma and less soft tissue damage which leads to decreasing of infection rate and rapid bone healing. However, the radiation exposure is still a disadvantage of this technique. A sonography that provides dynamic real time imaging may be used as an alternative technique for assisting MIPO. The aim of this study was to compare the effectiveness of MIPO in femoral shaft fracture between the sonography assisted and the fluoroscopy assisted.
Twenty-eight cadaveric limbs were subjected to create femoral shaft fracture. Then, sonography assisted reduction with temporary external fixation and MIPO were performed. Images of the sonography and the fluoroscopy were recorded including before reduction, after reduction and after MIPO in order to identify fracture displacements in anteroposterior and mediolateral directions. Moreover, the anterior and posterior distances from edge of the bone to the plate were measured to confirm plate position. The effectiveness of this technique was defined as the proper plate position and acceptable alignment after fixation. All distances from the sonography and the fluoroscopy were also analyzed and compared using Pearson correlation and Bland-Altman method to assess the agreements between two tests.
All of the subjects were met the criteria for acceptable alignment. We found only three femoral shaft fracture (11%) operated with MIPO by sonography assisted that showed slipped plate off femoral bones. According to Pearson correlation, there were good to excellent agreements in term of measuring fracture displacement before (Pearson Correlation >0.7) and after reduction (Pearson Correlation >0.7) between these two tests. There was moderate agreement regarding to evaluation of plate position (Pearson Correlation 03.-0.7). When we compared two methods of measurement using Bland-Altman plot, there were no statistical significant difference (P<0.05).
Images from the sonography could provide visualization of the fracture during reduction and MIPO as accurately as the radiography. Thus, the sonography assisted MIPO in femoral shaft fracture can be done effectively comparing with radiographic assisted.
微创钢板接骨术（MIPO）具有保留生物软组织的优势，包括保留骨血供、骨折血肿以及减少软组织损伤，从而降低感染率并促进骨折快速愈合。然而，辐射暴露仍是该技术的一个缺点。能够提供动态实时成像的超声检查可作为辅助MIPO的替代技术。本研究的目的是比较超声辅助和透视辅助下MIPO治疗股骨干骨折的有效性。
对28具尸体下肢造成股骨干骨折。然后，进行超声辅助复位并临时外固定，随后实施MIPO。记录超声和透视图像，包括复位前、复位后及MIPO后的图像，以确定骨折在前后位和内外侧位的移位情况。此外，测量骨边缘到钢板的前后距离以确认钢板位置。该技术的有效性定义为固定后钢板位置合适且对线良好。还使用Pearson相关性分析和Bland-Altman方法对超声和透视的所有测量距离进行分析和比较，以评估两种检查之间的一致性。
所有受试者均符合对线良好的标准。我们发现，仅3例（11%）超声辅助下MIPO治疗的股骨干骨折出现钢板从股骨上滑落的情况。根据Pearson相关性分析，这两种检查在测量复位前（Pearson相关性>0.7）和复位后（Pearson相关性>0.7）的骨折移位方面具有良好至极佳的一致性。在评估钢板位置方面存在中等一致性（Pearson相关性0.3 - 0.7）。当我们使用Bland-Altman图比较两种测量方法时，未发现统计学显著差异（P<0.05）。
超声图像在复位和MIPO过程中能够像X线摄影一样准确地显示骨折情况。因此，与X线摄影辅助相比，超声辅助MIPO治疗股骨干骨折可有效进行。
