超声检查在儿童膝关节骨折诊断中的初步应用

Preliminary application of ultrasonography in diagnosis of pediatric knee fractures

目的评价超声检查在儿童膝关节骨折诊断中的作用。方法对2015年9月至2019年3月北京大学第四临床医学院北京积水潭医院小儿骨科收治的膝关节骨折患儿27例临床资料进行回顾性分析。其中男18例,女9例;平均年龄7岁4个月(9个月~13岁5个月)。所有患儿在伤后2周内接受患侧膝关节X线和MRI检查以及双侧膝关节超声检查。以MRI结果作为诊断标准,将X线和超声检查结果分别与MRI结果进行比较。结果MRI诊断结果为关节内骨折14例(胫骨髁间嵴骨折8例、髌骨骨折4例、膝关节骨软骨骨折2例),关节外骨折13例(股骨远端骺损伤6例、胫骨近端骺损伤6例、股骨远端骺损伤合并胫骨近端骨折1例)。X线诊断准确率为96%(26/27)。超声检查诊断准确率为74%(20/27),对关节内骨折和关节外骨折的诊断准确率分别为57%(8/14)和92%(12/13)。超声与X线联合诊断的准确率为100%。结论超声检查可准确诊断儿童股骨远端骨折、胫骨近端骨折和髌骨骨折,但是对儿童胫骨髁间嵴骨折和膝关节骨软骨骨折等关节内骨折的诊断准确率较低;辅以超声检查可提高X线检查对儿童膝关节骨折诊断的准确率;当X线和超声检查均未发现骨折而超声提示有膝关节积液(血)时,应进一步行CT或MRI检查,以免漏诊儿童膝关节内骨折。

Objective To evaluate the role of ultrasonography in diagnosis of pediatric knee fractures.Methods Data of 27 child patients with knee fractures in Department of Pediatric Orthopedics in Beijing Jishuitan Hospital,the Fourth Clinical Medical Collage of Peking University between September 2015 and March 2019 were retrospectively analyzed.There were 18 males and 9 females with mean age of 7 years and 4 months(range,9 months-13 years and 5 months).All patients received X-rays and MRI for the injured knee,ultrasonography for the bilateral knees within 2 weeks after trauma.MRI was used as the standard in diagnosis,and the results of X-rays and ultrasonography were compared with MRI respectively.Results MRI showed there were 14 cases of intra-articular fractures(8 cases of tibial intercondylar eminence fractures,4 cases of patellar fractures and 2 cases of osteochondral fractures of the knee)and 13 cases of extra-articular fractures of the knee(6 cases of distal femoral physeal fractures,6 cases of proximal tibial physeal fractures and one case of distal femoral physeal fracture combined with proximal tibial fracture).X-rays diagnosed the fractures with accuracy of 96%(26/27).Ultrasonography diagnosed all the fractures with 74%(20/27),the intra-articular fractures with 57%(8/14)and the extra-articular fractures with 92%(12/13)accuracy,respectively.And combination of X-rays and ultrsonography diagnosed the fractures with 100%accuracy.Conclusion Ultrasonography find distal femoral fractures,proximal tibial fractures and patellar fractures in child accurately,but there are certain limitations for ultrasonography in detecting intra-articular fractures such as tibial eminence fractures and osteochondral fractures of the knee.Ultrasonography can be used as a useful assistance to X-rays,and the accuracy rate of diagnosis could increase when X-rays and ultrasonography are combined.When hemarthrosis or joint effusion is indicated by ultrasonography while no fracture signs are detected by X-rays and ultrasonography,CT or MRI should be further applied to avoid misdiagnosing intra-articular fractures.