超声在汶川地震骨折诊断中的应用
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摘要
目的探讨超声影像技术在地震灾害时对骨折伤员现场检查中的应用价值。方法2008年5月14日解放军总医院医疗队在四川省都江堰市汶川水磨镇和映秀镇地震现场使用便携式超声仪对260例地震中四肢或躯干等部位受伤,因疼痛活动受限的患者进行超声检查及救治,其中55例后期行X线检查(野战X线诊断车)。将超声诊断为骨折患者的声像图与X线检查结果进行对照分析。结果260例中超声诊断骨折89例(89/260,34.23%),表现为骨折断端错位,约0.6~7.4 mm不等,骨折部位周围软组织肿胀。其中超声检出肋骨骨折27例(断裂端<1 mm的细小骨折12例),锁骨骨折8例,胸骨骨折1例,上肢骨折21例(尺骨6例,掌指骨、桡骨及肱骨各5例),下肢骨折32例(外踝9例、股骨8例、跖骨5例、跟骨及髌骨各4例、距骨2例)。X线诊断骨折50例(50/55,90.91%,细小肋骨骨折7例)。结论与传统X线检查比较,超声分辨力高,对细小结构显示清晰,对细小骨折的诊断有较高的敏感性,且超声仪携带方便、在地震等自然灾害或大规模突发伤害环境下可快速检出骨折,为伤员的快速救治提供影像学诊断依据。
Objective To determine the value of ultrasonograhy in the diagnosis of fracture during the strong earthquake.Methods The ultrasonographic findings in 260 patients,who underwent the earthquake disaster in the Wenchuan region of Sichuan Province,were analyzed and compared with those of X-ray.Results Of all cases with trauma,89(34.2%) were diagnosed as varied types of fractures with ultrasound,which were characterized by the end of fracture dislocated at 0.6-7.4 mm and the surrounding soft tissue swelled.In 89 cases,rib fractures were observed in 27 cases(including 12 little fractures with a rapture of less than 1 mm),8 cases of clavicle fractures,1 case of sternum fracture,21 cases of upper limb fracture(6 ulnar bone,5 metacarpal and finger bone,and 5 radius and humerus),32 cases of lower lime fractures(9 external malleolus,8 femoral bones,5 toes bones,4 calcaneus and patellas,and 2 talus) and 50 cases of fractures(50/55,90.91%) were confirmed by X-ray including 7 little rib fractures.Conclusions The ultrasonography played an important role in the diagnosis of fracture in traumatic settings of disaster area,which may suggest a potential alternative way for diagnosis of fracture.
Objective To determine the value of ultrasonograhy in the diagnosis of fracture during the strong earthquake.Methods The ultrasonographic findings in 260 patients,who underwent the earthquake disaster in the Wenchuan region of Sichuan Province,were analyzed and compared with those of X-ray.Results Of all cases with trauma,89(34.2%) were diagnosed as varied types of fractures with ultrasound,which were characterized by the end of fracture dislocated at 0.6-7.4 mm and the surrounding soft tissue swelled.In 89 cases,rib fractures were observed in 27 cases(including 12 little fractures with a rapture of less than 1 mm),8 cases of clavicle fractures,1 case of sternum fracture,21 cases of upper limb fracture(6 ulnar bone,5 metacarpal and finger bone,and 5 radius and humerus),32 cases of lower lime fractures(9 external malleolus,8 femoral bones,5 toes bones,4 calcaneus and patellas,and 2 talus) and 50 cases of fractures(50/55,90.91%) were confirmed by X-ray including 7 little rib fractures.Conclusions The ultrasonography played an important role in the diagnosis of fracture in traumatic settings of disaster area,which may suggest a potential alternative way for diagnosis of fracture.
引文
1 Kara M,Dikmen E,Erdal HH,et al.Disclosure of unnoticed rib fractures with the use of ultrasonography in minor blunt chesttrauma.Eur J Cardiothorac Surg,2003,24(4):608-613.
2张宏波,韦福康,袁朝新,等.骨折超声显像的实验研究.中国超声医学杂志,2002,18(9):649-652.
2张宏波,韦福康,袁朝新,等.骨折超声显像的实验研究.中国超声医学杂志,2002,18(9):649-652.
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