儿童髋关节滑膜炎合并滑膜嵌顿的B超诊断

Ultrasonic diagnosis of hip synovitis associated with synovial incarceration in children

目的 探讨B超检查辅助诊断儿童髋关节滑膜嵌顿症的方法。方法 18例患儿中男11例 ,女 7例 ,年龄 4～ 12岁 ,平均 9岁 ,均为单髋病变 ,左 8例 ,右 10例。应用DiasonicSynergy彩色超声仪检查 ,探头频率 10MHz。髋关节中立位 ,探头置于患侧和正常侧髋关节的前方、大转子的上方以及髋关节的内下方分别观察A、B、C型皱襞 ,可见关节间隙内团状强回声。结果 18例中 3例行走或下蹲时出现弹响 ,疼痛和典型体征随即消失 ,双下肢等长 ,行走自如 ;6例腰麻下手法复位 ,听到或感到弹响后关节活动自如 ;6例手法复位失败 ,行患肢皮牵引 ,适当应用抗生素 ,辅助微波理疗 ,骨盆倾斜逐渐消失 ,双下肢逐渐恢复等长而治愈 ;3例尚无明显效果 ,经手术治疗 ,症状体征消失 ,关节积液作细菌培养未见细菌生长 ,切除的滑膜组织病理检查报告为慢性非特异性炎症。B超复查 ,关节间隙团状回声消失。 18髋B超可见髋关节间隙增宽 ,内见液性暗区 ,深约 8～ 13mm不等 ,关节腔可探测团状强回声 ,内部回声不均匀。正常侧髋关节间隙 3～ 5mm ,腔内无团状回声。A型皱襞致病 4例、B型 2例、C型 12例 ,分别占 2 2 .2 % (4/ 18)、11.1% (2 / 18)和 6 6 .7% (12 / 18)。B超发现 1例C型皱襞嵌顿病例 ,保守治疗无效 ,经手术治疗痊愈并被证实。

Objective To describe a new modality to diagnose hip synovial incarceration in children.Methods Eighteen patients (male 11,female 7) with hip synovial fold incarceration were studied.Their mean age was 9 years (range:4-12years).The involvement was unilateral,8 affecting the left side and 10 the right. 10?MHz probe (Diasonic Synergy B Mode Ultrasonic Apparatus) was applied anterior to hip joint,superior to greater trochanter and antero inferior to the hip joint for type A,B and C fold respectively.Results The space between femoral head and acetabulum was widened in all cases,showing a dark area with 8- 13?mm in depth.Mass echo with irregular signal was seen in hip articular space.In contrast,normal hip joint space was 3- 5?mm in depth without mass echo.A,B and C type fold incarceration accounted for 22% ( n =4),11% ( n =2) and 66% ( n =12) respectively.One case with type C fold incarceration diagnosed by ultrasound was confirmed intra operatively.Conclusions Incarcerated synovial fold is the pathological base of hip synovitis.It can be diagnosed by B mode ultrasound.