摘要目的:探讨超声监测下手风琴技术促进胫骨搬移术后对合端骨愈合的临床效果和影像学表现。方法:回顾性分析2018年5月至2019年10月山西医科大学第二医院骨科收治的16例在超声监测下利用手风琴技术促进对合端骨愈合的胫骨搬移术后患者的临床资料。男性14例，女性2例，年龄（45.3±14.3）岁（范围：6~61岁）。在实施骨搬移之前，胫骨骨缺损长度为（6.0±2.6）cm（范围：2.0~12.1 cm）。手风琴技术的操作步骤：加压2周、暂停调节12 d、牵开2周、回缩2周，之后停止操作，巩固对合端骨质矿化。在治疗过程中，应用超声监测对合端的血肿大小、血流信号的Adler分级、新生骨痂变化等。应用X线检查监测对合端的骨愈合情况。采用paley愈合标准评价患者的骨性愈合情况及功能恢复情况。采用Pearson相关系数分析对合端血肿大小与血流阻力指数及对合端骨愈合时间的相关性。结果:手风琴操作过程中，超声检查可见回缩前对合端周围血流信号的Adler分级逐渐升高，回缩开始后逐渐降低，但骨痂矿化程度持续升高。对合端加压2周时，14例患者超声检查发现对合端出现血肿，X线检查显示对合端均骨性愈合，愈合时间为（30.8±4.9）周（范围：23~40周），且血肿大小与对合端骨愈合时间呈线性负相关（ r=-0.819， P<0.01）；2例患者未发现血肿，连续观察20周后，对合端仍无明显的骨痂连接，行骨皮质剥脱术后，超声检查显示对合端出现血肿，继续行手风琴技术治疗，对合端分别于术后第30、32周骨性愈合。16例患者加压2周时的血肿大小与牵开2周时血流阻力指数呈线性负相关（ r=-0.801， P<0.01）；患者术后随访（14.5±3.2）个月（范围：10.6~20.2个月）。末次随访时，12例患者的Paley愈合标准评价结果为优，4例为良。 结论:手风琴技术中施加的牵拉及压缩应力可促进对合端的骨愈合，超声可监测对合端骨愈合早期的愈合迹象，帮助判断骨愈合情况。

abstractsObjective:To explore the imaging features and clinical effect of accordion maneuver in promoting the bone healing at the docking site after tibial transport under ultrasonic monitoring.Methods:Retrospective analysis was conducted on the clinical data of 16 patients with tibial bone transport who were admitted to the Department of Orthopedics, the second Hospital of Shanxi Medical University from May 2018 to October 2019. All the patients were treated with accordion maneuver to promote bone healing at the docking site under ultrasound monitoring. There were 14 males and 2 females, aged (45.3±14.3) years (range: 6 to 61 years). Before tibial bone transport, the length of the tibial defect of 16 patients was (6.0±2.6) cm (range: 2.0 to 12.1 cm). The operation steps of accordion maneuver were as follows: pressurization for 2 weeks, suspension for 12 days, distraction for 2 weeks, retraction for 2 weeks, and then stop the operation to consolidate the bone mineralization. During accordion treatment, ultrasound was used to monitor the size of hematoma, Adler grade of blood flow signal and the changes of new callus in and around the docking site. X-ray was performed to monitor bone healing at the docking site. Pearson correlation coefficient was used to analyze the correlation between the size of hematoma, the resistance index of blood flow signal and the bone healing time of the docking site. Paley healing criterion was used to evaluate the bone healing and functional recovery of the patients.Results:During accordion maneuver, ultrasound examination showed that the Adler grade of blood flow signals around the docking site increased gradually before retraction and then decreased gradually, but the degree of callus mineralization continued to increase gradually. After 2 weeks of pressure on the docking site, hematoma was observed in 14 patients by ultrasound examination. X-ray showed that all docking sites had bony healing, with the healing time of (30.8±4.9) weeks (range: 23 to 40 weeks).The size of the hematoma was negatively correlated with the healing time of the docking site ( r=-0.819, P<0.01). No hematoma was found in 2 patients, and after continuous observation for 20 weeks, there was still no obvious callus connection at the docking site. After bone cortical removal, ultrasound examination showed hematoma formed at the docking site. Accordion maneuver was continued, and the docking site healed at 30 and 32 weeks after surgery, respectively. There was a negative linear correlation between hematoma size at 2 weeks of compression and the blood flow resistance index at 2 weeks of retraction in 16 patients ( r=-0.801, P<0.01). The patients were followed-up for (14.5±3.2) months (range: 10.6 to 20.2 months). At the last follow-up, 12 patients were evaluated as excellent and 4 were evaluated as good by Paley healing criteria. Conclusion:The distraction and compression stress applied in accordion maneuver can promote bone healing at the docking site, and ultrasound can monitor early signs of bone healing at the docking site to help determine the tendency of bone healing.