磁共振不同序列检查在儿童肘关节外伤诊断中的应用价值

Clincal value of different MRI sequences in the diagnosis of elbow trauma in children

目的探讨磁共振(MRI)不同序列检查在儿童肘关节外伤诊断中的应用价值。方法选取台州骨伤医院2015年3月至2019年3月收治的肘关节外伤患儿78例作为研究对象。所有患儿行X线和MRI检查,其中,MRI检查序列包括三维双重回波稳态序列(3D-DESS)、快速自旋回波序列(TSETIWI)、T1快速反转恢复序列(T1-TIRM)、脂肪抑制质子密度加权像(FS-PDWI),分析两种检查结果的差异。结果MRI不同序列证实,骨骺骨折62例。按照Salter-Harris骨折分型分布:Ⅱ型23例(37.10%)>Ⅲ型17例(27.42%)>Ⅳ型12例(19.35%)>Ⅰ型10例(16.13%)>Ⅴ型0例(0.00%),差异有统计学意义(χ2=6.126,P=0.025)。78例患儿肘关节外伤中,73例出现骨髓水肿,其中,距离骺板1 cm范围内骨髓水肿62例,距离骺板1 cm以外11例,无骨髓水肿5例,骨髓水肿与骨骺骨折具有相关性(r=0.174,P=0.006)。患儿肘关节骨骺损伤Ⅰ~Ⅳ型均可伴有关节软骨损伤,3D-DESS对关节软骨损伤有较好的显示效果。结论MRI不同序列检查对儿童肘关节外伤的诊断具有很高的准确性,对减少儿童骨骺骨折、骨髓水肿、关节软骨损伤的误诊、漏诊率具有重要意义。

Objective To analyze the clinical value of different MRI sequences in the diagnosis of elbow trauma in children.Methods From March 2015 to March 2019,78 children with elbow joint injury were studied.All patients were examined by X-ray and MRI,including 3D-DESS,TSETIWI,T1-TIRM and FS-PDWI.The differences between the two methods were analyzed.Results A total of 62 cases of epiphyseal fracture were confirmed by MRI.According to the distribution of Salter Harris fracture:23 cases of typeⅡ(37.10%)>17 cases of typeⅢ(27.42%)>12 cases of typeⅣ(19.35%)>10 cases of typeⅠ(16.13%)>0 case of typeⅤ(0.00%),the difference was statistically significant(χ2=6.126,P=0.025).Among 78 children of elbow joint injury,73 cases had bone marrow edema,of which 62 cases were within 1 cm from epiphyseal plate,11 cases were outside 1 cm from epiphyseal plate,5 cases were without bone marrow edema,and there was a correlation between bone marrow edema and epiphyseal fracture(r=0.174,P=0.006).TypeⅠ-Ⅳepiphysis injury of elbow joint in children could be accompanied with articular cartilage injury,and 3D-DESS had good effect on articular cartilage injury.Conclusion Different sequences of MRI have high accuracy in the diagnosis of elbow joint injury in children,which is of great significance in reducing misdiagnosis and missed diagnosis rate of epiphyseal fracture,bone marrow edema and articular cartilage injury in children.