高频超声在新生儿锁骨骨折中的诊断价值探讨

To study the application value of high frequency ultrasonography in the diagnosis of neonatal clavicular fracture

目的研究高频超声在新生儿锁骨骨折筛查、诊断以及愈合过程中动态观察与疗效评估中的应用价值。方法利用高频超声技术对存在锁骨骨折高危因素或临床检查怀疑锁骨骨折的新生儿进行筛查，若超声显示骨皮质连续性中断、低回声区或无回声区等异常声像图，则诊断为锁骨骨折，并拍摄X线片，以X线检查作为诊断金标准，进行对比分析。间隔10d、20d后，分别进行第2次、第3次高频超声检查，对比骨痂形成与正常锁骨声像图。结果完成全程研究的106例锁骨骨折新生儿中，第1次高频超声检查阳性103例，阴性3例，敏感度97．2％，特异度100％，X线与超声检查方法阳性率比较，无统计学意义（P=0．083）。在骨折愈合过程中，骨痂声像图显示骨痂边缘骨皮质为条索状弱强回声、骨痂中间髓腔部分为无回声区或低回声区中有散在弱强回声斑点，声像强度与同期骨痂边缘骨皮质强度相似，随着愈合进展骨痂边缘骨皮质逐渐增厚，中间回声斑点逐渐增多增大，回声强度逐渐增强。结论高频超声技术诊断新生儿锁骨骨折，具有可靠、无X线损害的优点，值得在新生儿锁骨骨折筛查与愈合过程中的动态观察、疗效评估中推广应用。

Objefive To study the application value of high frequency uhrasonography in the diagnosis of neonatal clavicular fracture, dynamic observation of healing process and evaluation of the effect. Methods We used high frequency ultrasound technique to screen the neonatal clavicular fraetur who had clavicular fractures risk factors. If they had any contiguous bony cortex interrupt, a hypoechoie or anechoic areas and other abnormal sonogram, we thought of them as neonatal clavicular fracture, and then took X-ray examination as the gold standard, and then we compared the two examination methods. After 10 days and 20 days, the neonates who had Clavicular fractures were took to have the second and third high frequency ultrasound examination of bilateral subclavian, and we compared the clavicular fractur healing bone callus sonograms with the normal clavicular sonograms. Results There were 106 cases of neonatal clavicular fracture who had completed the study. In the first high frequency ultrasonic examination, 103 cases were positive and 3 cases were negative, the sensitivity was 97.2% and the specificity was 100%. The positive rate of the high frequency ultrasonic and X-ray examination was no significant difference （ P = 0. 083 ）. In the process of fracture healing, bone callus sonograms were presented funicular low strong echo in the calluses marginal cortical bone, and the sonograms of the middle part of the medullary cavity of calluses were presented no echo areas or low echo areas, some spots of low strong echo were scattered in the areas, the echo intensity was same as the callus marginal cortical bone strength at the same time. The marginal bone cortex Of callus was gradually thickening with the process of callus growth healing , the numbers of spot intermediate echo were gradually increased and the echo intensity was increases gradually at the same time. Conclusions The high frequency ultrasound technology has the advantage that is reliable, without damage of X ray in the screening diagnosis of neonatal clavicular fractures. It has a big advantage especially in dynamic observation of healing process on the neonatal clavicle frac-ture and efficacy assessment. It is worthy of popularization and application.