肌骨超声在小儿闭合性胫腓骨远端骨骺损伤的诊断价值

Diagnostic Value of Musculoskeletal Ultrasound in Closed Distal Epiphysis Injury of Tibia and Fibula in Children

目的:讨肌骨超声在小儿闭合性胫腓骨远端骨骺损伤的诊断价值。方法:32例小儿闭合性胫腓骨远端骨骺损伤患者均行X射线、肌骨超声及磁共振检查,以磁共振检查结果为诊断的金标准。比较X射线与肌骨超声诊断结果、两种检查手段分型诊断结果、诊断效能以及诊断影像质量。结果:胫腓骨远端骨骺撕脱23例,胫腓骨远端骨折4例、胫腓骨远端骨骺合并干骺端骨折3例、胫腓骨远端骨骺分离2例。其中,胫腓骨远端骨骺撕脱,肌骨超声和X射线诊断准确性存在差异(P<0.05);32例患者经MRI分型:Ⅰ型7例、Ⅱ型9例、Ⅲ型7例、Ⅳ型6例、Ⅴ型3例。其中,肌骨超声Salter-Harris分型诊断阳性率为87.50%,X射线为75.00%,两种分型诊断阳性率存在差异(P<0.05);肌骨超声对小儿闭合性胫腓骨远端骨骺损伤诊断的灵敏度以及阴性预测值均高于X射线检查(P<0.05);肌骨超声诊断影像质量总优良率高于X射线检查(P<0.05)。结论:与传统X射线检查相比,肌骨超声对小儿闭合性胫腓骨远端骨骺损伤的诊断准确性更高,对骨骺的分型诊断的准确性及灵敏度强,且诊断影像质量更高。

Objective:To explore the diagnostic value of musculoskeletal ultrasound in closed epiphyseal injury of distal tibia and fibula in children.Methods:32 children with closed epiphyseal injury of distal tibia and fibula were examined by X-ray,musculoskeletal ultrasound and magnetic resonance,and the results of magnetic resonance examination were the gold standard for diagnosis.To compare the diagnosis results of X-ray and musculoskeletal ultrasound,the classification diagnosis results of the two inspection methods,the diagnostic efficiency and the diagnostic image quality.Results:There were 23 cases of distal tibia and fibula epiphysis avulsion,4 cases of distal tibia and fibula fracture,3 cases of distal tibia and fibula epiphysis combined with metaphyseal fracture,and 2 cases of distal tibia and fibula epiphysis separation.Among them,the accuracy of ultrasound and X-ray diagnosis of distal epiphyseal avulsion of tibia and fibula was different(P<0.05).32 patients were classified by MRI:7 cases were typeⅠ,9 cases were typeⅡ,7 cases were typeⅢ,6 cases were typeⅣand 3 cases were typeⅤ.Among them,the positive rate of Salter-Harris classification of musculoskeletal ultrasound was 87.50%,and that of X-ray was 75.00%.There was a difference between the two types of diagnosis(P<0.05).The sensitivity and negative predictive value of musculoskeletal ultrasound in the diagnosis of closed distal epiphysis injury of tibia and fibula in children were higher than those of X-ray examination(P<0.05).The overall excellent and good rate of musculoskeletal ultrasound diagnosis image quality was higher than that of X-ray examination(P<0.05).Conclusion:Compared with the traditional X-ray examination,musculoskeletal ultrasound is more accurate in the diagnosis of closed epiphyseal injury of distal tibia and fibula in children,and has stronger accuracy and sensitivity in the classification diagnosis of epiphysis,and the diagnostic image quality is higher.