超声引导与透视引导下经皮撬拨复位治疗儿童严重移位桡骨颈骨折：临床与影像学结果的对比分析
Ultrasound-guided vs. fluoroscopy-guided percutaneous leverage reduction for severely displaced radial neck fractures in children: a comparative analysis of clinical and radiological outcomes.
作者信息
Wu Xing, Xia Jingdong, Li Xiongtao, Chen Xiaoliang, Wang Si, Shen Xiantao
机构信息
Department of Pediatric Orthopedic Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, 100 Xianggang Road, Wuhan, 430016, China.
出版信息
BMC Musculoskelet Disord. 2025 Feb 1;26(1):106. doi: 10.1186/s12891-025-08312-9.
BACKGROUND
Ultrasound (US) is a promising alternative to fluoroscopy (FL) for guiding percutaneous leverage reduction of displaced radial neck fractures in children. However, few studies have compared these modalities. This study aims to compare both the accuracy and efficacy of FL-guided versus US-guided percutaneous pinning in the treatment of radial neck fracture.
METHODS
Seventy-three children with displaced radial neck fractures were consecutively enrolled and assigned to the US or FL group. In all the patients, fractures were reduced with the percutaneous pin leverage technique. The patients were divided into two groups: the FL-guided group and the US-guided group. Baseline information, radiographs, and clinical results according to the criteria suggested by Metaizeau and complications were analyzed. Final Metaizeau criteria were categorized into excellent, good, fair, and poor.
RESULTS
The success rates for closed reduction were 100% for the US group and 91.2% for the FL group. The US group exhibited a significantly shorter operation time compared to the FL group (24.77 ± 8.00 min vs. 42.21 ± 15.18 min; P < 0.01). Additionally, the US group had a significantly lower number of FL images and radiation dose (3.59 ± 1.57 times, 9.56 ± 6.08 mGy) than the FL group (22.26 ± 8.07 times, 69.68 ± 34.70 mGy; P < 0.001). Reduction quality did not significantly differ between the groups according to the Metaizeau reduction classification (P = 0.130). According to the Metaizeau classification criteria, there was no significant difference between the two groups, including post-operative complications.
CONCLUSION
Ultrasound-guided techniques offer a viable alternative for the treatment of displaced radial neck fractures in paediatric patients by minimising radiation exposure, expediting operative time and facilitating reduction.
LEVEL OF EVIDENCE
Therapeutic Level III.
背景
超声（US）有望替代荧光透视（FL）用于指导儿童移位性桡骨颈骨折的经皮撬拨复位。然而，很少有研究对这两种方式进行比较。本研究旨在比较荧光透视引导与超声引导下经皮穿针治疗桡骨颈骨折的准确性和疗效。
方法
连续纳入73例移位性桡骨颈骨折患儿，并将其分为超声组或荧光透视组。所有患者均采用经皮穿针撬拨技术进行骨折复位。患者分为两组：荧光透视引导组和超声引导组。分析患者的基线信息、X线片以及根据Metaizeau标准得出的临床结果和并发症情况。最终的Metaizeau标准分为优、良、可、差。
结果
超声组闭合复位成功率为100%，荧光透视组为91.2%。与荧光透视组相比，超声组的手术时间明显更短（24.77±8.00分钟 vs. 42.21±15.18分钟；P<0.01）。此外，超声组的荧光透视图像数量和辐射剂量明显低于荧光透视组（分别为3.59±1.57次，9.56±6.08毫戈瑞）（荧光透视组为22.26±8.07次，69.68±34.70毫戈瑞；P<0.001）。根据Metaizeau复位分级，两组间的复位质量无显著差异（P=0.130）。根据Metaizeau分级标准，两组间无显著差异，包括术后并发症。
结论
超声引导技术通过减少辐射暴露、缩短手术时间并促进复位，为小儿移位性桡骨颈骨折的治疗提供了一种可行的替代方法。
证据水平
治疗性III级。
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