肌骨超声诊断儿童闭合性胫腓骨远端骨折的临床价值

Clinical diagnostic value of musculoskeletal ultrasound in children with closed distal tibia and fibula fractures

目的研究肌骨超声诊断在儿童闭合性胫腓骨远端骨折中的临床价值。方法前瞻性选取2021年3月至2023年5月入中国人民解放军南部战区总医院的80例急性踝关节外伤患儿为观察对象。所有患儿均进行肌骨超声、X线检查、多层螺旋CT检查,将多层螺旋CT检查结果作为临床诊断参考标准,分析并对比肌骨超声、X线以及二者联合检查在胫腓骨远端骨折中的诊断效果、骨折类型、骨折分型,总结儿童闭合性胫腓骨远端骨折肌骨超声的直接表现。结果80例急性踝关节外伤患儿中,多层螺旋CT诊断闭合性胫腓骨远端骨折患儿67例,非闭合性胫腓骨远端骨折13例。联合检查与多层螺旋CT检查结果趋于一致(Kappa=1.000),肌骨超声检查结果与多层螺旋CT检查结果一致性较好(Kappa=0.932),X线检查结果与多层螺旋CT检查结果一致性一般(Kappa=0.501)。联合检查的诊断效能明显最优,但单项检查中肌骨超声灵敏度、准确度优于X线检查。对67例确诊闭合性胫腓骨远端骨折患儿开展进一步骨折类型诊断,肌骨超声检出所有骨折,但存在1例误诊,X线检查存在17例误诊,肌骨超声准确度明显高于X线检查,差异有统计学意义(P<0.05)。67例闭合性胫腓骨远端骨骺骨折参考Salter-Harris分型诊断,结果显示肌骨超声与X线检查在分型诊断中差异无统计学意义(P>0.05)。闭合性胫腓骨远端骨折的肌骨超声直接表现为:骨骺板有增宽现象,连续的骨皮质存在中断现象,骨折部断端有轻微分离、移位情况,略宽的骨折线可渗入液体或者血肿,周围组织水肿,滑膜增厚。结论在儿童闭合性胫腓骨远端骨折的诊断中,相对于X线检查而言,肌骨超声诊断效能更高,但二者联合效果最佳。肌骨超声在骨折类型诊断中效果优越,可作为儿童闭合性胫腓骨远端骨折筛查的首选方式,但在区分骨折分型中只能作为辅助手段。

Objective To investigate the clinical diagnostic value of musculoskeletal ultrasound in children with closed distal tibia and fibula fractures.Methods Eighty children with acute ankle joint trauma admitted to General Hospital of Southern Theatre Command of PLA from March 2021 to May 2023 were prospectiveiy seleted as the observation objects.Musculoskeletal ultrasound,X-ray examination and multi-slice spiral CT examination were performed in all children,and the results of multi-slice spiral CT examination were taken as the reference standard for clinical diagnosis.The diagnostic effect of musculoskeletal ultrasonography,X-ray and combined examination in distal tibia-fibula fractures,fracture types,fracture types were analyzed and compared,and direct findings of musculoskeletal ultrasound in closed distal tibiofibular fractures in children had been summarized.Results Among the 80 children with acute ankle joint trauma,according to the diagnosis of multislice spiral CT,67 cases were diagnosed with closed distal tibia-fibular fracture epiphysis injury and 13 cases were non-epiphysis injury.The results of combined examination and multi-slice spiral CT were consistent(Kappa=1.000).The results of musculoskeletal ultrasonography were consistent with those of multi-slice spiral CT(Kappa=0.932).The results of X-ray examination were generally consistent with those of multi-slice spiral CT(Kappa=0.501).The diagnostic efficiency of combined examination was obviously the best,but the sensitivity and accuracy of musculoskeletal ultrasonography in single examination were better than that of X-ray examination.Further diagnosis of fracture types was carried out in 67 children with confirmed closed distal tibia and fibula fractures.Musculoskeletal ultrasound detected all fractures,but there was misdiagnosis in 1 case and X-ray examination in 17 cases.The accuracy of musculoskeletal ultrasound was significantly higher than X-ray examination,the difference was statistically significant(P<0.05).Sixty-seven cases of closed distal tibia and fibula fractures were diagnosed according to Salter-Harris classification,and there was no statistical difference between musculobone ultrasound and X-ray in classification diagnosis(P>0.05).Musculoskeletal ultrasound directly showed:widening of epiphyseal plate,interruption of continuous cortical bone,slight separation and displacement of fracture end,infiltration of fluid or hematoma in slightly wider fracture line,edema of surrounding tissue,and thickening of synovial membrane.Conclusion Compared with X-ray examination,musculoskeletal ultrasound has higher diagnostic efficacy,but the combination of the two has the best effect,and musculoskeletal ultrasound has superior effect in the diagnosis of fracture types,and can be used as the first choice for screening children with closed distal tibia and fibula fractures,but it can only be used as an auxiliary means in distinguishing fracture types.