超声对儿童髋关节暂时性滑膜炎的诊断价值

Diagnostic value of ultrasound in children with temporary hip synovitis

目的对比健康儿童与髋关节暂时性滑膜炎患儿的超声表现,探讨髋关节暂时性滑膜炎有效的超声诊断指标及其诊断价值。方法回顾性收集2020年1月至2022年7月于重庆医科大学附属儿童医院就诊的320例健康儿童及200例髋关节暂时性滑膜炎患儿,均进行髋关节超声检查。分析滑膜炎患儿与健康对照儿童的髋关节颈前间隙宽度、关节腔积液、关节囊壁厚度、关节轮廓、关节囊血供等超声指标。绘制ROC曲线,分析超声指标独立及联合对髋关节暂时性滑膜炎的诊断效能。结果3.7%(24/640)的健康儿童髋关节囊可呈现凸起状态;10%(64/640)的健康儿童关节腔内可出现少量生理性积液;颈前间隙平均值(0.55±0.10)cm;关节囊前、后壁均值分别为(0.25±0.07)、(0.25±0.06)cm,其差异无统计学意义(P>0.05)。200例患儿共261髋受累,78.4%(228/261)的滑膜炎患儿关节囊呈现凸起轮廓;261个患侧髋关节腔内均可见积液,平均值(0.84±0.21)cm;患侧颈前间隙平均值(0.89±0.21)cm;关节囊壁厚度(0.25±0.47)cm,与健康正常组关节囊前、后壁比较,差异均无统计学意义(P>0.05);健侧与患侧关节囊血供差异无统计学意义(P>0.05)。颈前间隙、关节腔积液、双侧颈前间隙之差、双侧关节腔积液之差及关节囊轮廓5项超声指标中,双侧颈前间隙之差诊断髋关节暂时性滑膜炎的ROC曲线下面积为0.98,大于其他超声指标,其最佳截断值为0.1 cm。联合指标中,颈前间隙>0.66 cm+关节腔积液量之差>0.16 cm的诊断效能最佳,ROC曲线下面积为0.97。结论滑膜炎患儿关节囊及滑膜并未显著增厚,血供也未见明显增多;双侧颈前间隙之差及颈前间隙联合双侧关节腔积液之差对髋关节暂时性滑膜炎具有良好的诊断效能,为超声诊断髋关节暂时性滑膜炎提供了依据。

Objective To compare the ultrasonic findings of healthy children and children with temporary hip synovitis,and to investigate the effective ultrasonic diagnostic indices and their diagnostic value in temporary hip synovitis.Methods From January 2020 to July 2022,320 healthy children and 200 children with temporary hip synovitis were recruited from the Chongqing Medical University Children's Hospital.The breadth of the anterior femoral neck space(ultrasonoimagedata joint space,UJS),joint effusion,joint capsule wall thickness,joint shape,and blood supply of the joint capsule were measured.The diagnostic efficacy of ultrasonic markers,alone or in combination,in hip transient synovitis was examined by receiver operating characteristic(ROC)curve analysis.Results Approximately 3.7%of healthy children(24/640)had a protruding hip capsule,and 10%(64/640)had a small amount of physiologic fluid accumulation in the joint cavity.The average UJS was(0.55±0.10)cm.The mean thickness of the anterior and posterior walls of the articular capsule was(0.25±0.07)cm and(0.25±0.06)cm,respectively,with no statistical difference(P>0.05).The majority(78.4%,228/261)of children with synovitis presented a convex articular capsule profile.Fluid accumulation was observed in the lumen of 261 affected hip joints,with an average value of(0.84±0.21)cm.The UJS on the affected side was(0.89±0.21)cm.The wall thickness of the articular capsule was(0.25±0.47)cm,and there was no significant difference in the thickness of the anterior and posterior walls of the articular capsule between children with temporary hip synovitis and the healthy group(P>0.05).There was no significant difference in blood supply between the healthy side and affected side(P>0.05).Among the five ultrasonic indexes(UJS,articular effusion,bilateral UJS difference,bilateral articular effusion difference,and articular capsule contour),the area under the ROC curve of bilateral UJS difference was 0.98,which was larger than that of the other ultrasonic indexes,and the best cut-off value was 0.1 cm.Among the joint indexes,the diagnostic efficiency of UJS>0.66 cm+articular effusion difference>0.16 cm was the best,and the area under the ROC curve was 0.97.Conclusion The articular capsule and synovial membrane in children with synovitis do not significantly thicken,and the blood supply does not significantly increase.The difference of bilateral UJS and the difference of UJS combined with bilateral joint effusion have good diagnostic efficacy for temporary hip joint synovitis,which provides a basis for ultrasound diagnosis of temporary hip joint synovitis..