目的：探讨术中超声监测指导儿童前臂骨折闭合复位弹性髓内针内固定的可行性。方法回顾性分析2010年11月至2013年7月我们实施的130例儿童前臂骨折闭合复位弹性髓内针内固定术患儿临床资料。手术均由本院同一组医生完成。根据术中监测骨折复位情况分为两组：采用术中超声监测加间断 X 线摄片进行骨折闭合复位弹性髓内针内固定术65例，为实验组；采取间断 C 臂摄片了解复位情况及内固定位置情况65例，为对照组。结果在术中超声监测下，实验组全部闭合复位成功，并成功穿针固定。术毕 X 线 C 臂照射确证复位内固定满意，闭合复位及穿针过程无神经血管损伤发生。与对照组相比，实验组所需时间更少[（13±5）min vs （19±6）min，P ＝0．03]，闭合复位成功率更高（100％ vs 73．8％，P ＜0．01），C 臂照射次数明显减少（1．2±0．3 vs 5．1±0．7，P ＜0．01）。结论术中超声监测加 X 线片可清楚显示骨折断端、远端骨骺骺板及周围软组织形状及变动情况，显示闭合复位术中骨折的复位过程及弹性髓内针在骨折端的通过情况，闭合复位成功率高，且一次复位成功率高，手术时间短，术中 X 线 C 臂照射次数少，方法简单易行，值得临床推广。%Objective To explore the ultrasonography application in closed reduction and flexible intr-amedullary nail fixation for children's forearm fracture.Methods A retrospective analysis from November 201 0 to July 201 3 about 1 30 cases in our hospital.Each operation was carried out by the same doctor.According to the intraoperative monitoring,patients were divided into two groups:the use of intraoperative ultrasound monito-ring and interrupted X-ray in 65 cases (experimental group);discontinuous C arm X-ray film to the other 65 patients (control group).Results Successful closed reduction and pinning were perform for all of the 65 ex-perimental group cases.No neurovascular injury occurred during fracture reduction and pinning.Compared with control group,the less time needed (1 3 ±5 minutes vs.1 9 ±6 minutes,P =0.03),higher success rate of closed reduction (1 00% vs 73.8%,P <0.01 )and significantly reduce C arm radiation (1 .2 ±0.3 vs.5.1 ± 0.7,P <0.01 )for the experimental group. Conclusions It is feasible and safe to use intraoperative ultrasound monitoring in closed reduction and flexible intramedullary nail fixation for children's forearm fracture.Intraoper-ative ultrasonography application could gain success rate of closed reduction especially success rate at first time,and significantly decrease operation duration and X-ray exposure risk.
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