超声在学龄期前儿童X线肘关节隐匿骨折中的诊疗应用

Ultrasonic applications in the diagnosis and treatment of radiographic occult fractures of elbow in preschool children

肘关节是儿童最常见的骨折部位,诊疗不当影响患儿生长发育。肘关节二次骨化中心随着年龄增长逐渐骨化,在X线上依次显影。2010年,学者Waters提出X线隐匿骨折的概念,其中肱骨远端骨骺分离骨折、肱骨内髁骨折、肱骨外髁骨折、孟氏骨折Bado I型、桡骨头骨骺分离骨折多见于学龄期前儿童(≤6岁),称为学龄期前X线隐匿骨折(the radiographic appearance seemed harmless fractures before school age,TRASH-FBSA)。二次骨化中心未骨化前单纯依靠X线诊断困难,容易漏诊误诊。超声诊疗具有无辐射、多方向实时动态扫描、关节软骨显示清晰、专业医生和操作者一体化等优点,动态下诊断、复位、固定TRASH-FBSA五种骨折有明显优势,诊断明确,治疗精准,值得临床推广。

Elbow fracture is one of the most common fractures in children.And secondary ossification center appears gradually with advancing age on radiography.In 2010,Waters proposed radiographic occult fracture.Transphyseal separation of distal humerus,medial humeral condyle fracture,lateral humeral condyle fracture,radial head osteochondral separation and Monteggia fracture(minimal ulnar bow type)are difficult to diagnose based upon radiographic films alone because of unossified secondary ossification center or a suspicious non-alignment of anatomical cartilage of elbow joint.These five lesions above are defined as radiographic appearance seemed harmless fractures before school age(TRASH-FBSA).TRASH-FBSA should be considered when swelling occurs at injured site without radiographic fracture features.Also misdiagnosis plus an improper management may cause elbow dysfunction and deformity.This review summarized the applications of ultrasound for properly managing TRASH-FBSA.