儿童髋关节滑膜唇皱襞嵌顿症的超声影像研究  

The Labral Plicae Entrapment Syndrome of Hip in Children:An Ultrasonography Study

作　　者：刘菊先[1] 杨志刚[2] 罗燕[1] 彭玉兰[1] 刘利君[3] 向波[3] 刘敏[3] 杜新萍[3] 彭明惺[3] 

机构地区：[1]四川大学华西医院超声科,成都610041 [2]四川大学华西医院放射科,成都610041 [3]四川大学华西医院小儿外科,成都610041

出　　处：《四川大学学报（医学版）》2009年第1期63-67,共5页Journal of Sichuan University(Medical Sciences)

摘　　要：目的探讨儿童髋关节滑膜唇皱襞嵌顿症(LPEH)超声影像特征及其超声诊断价值。方法①采用双盲法,在32例儿童尸体髋关节上建立26侧滑膜唇皱襞嵌顿模型和38侧假模型并进行超声观察,计算超声对嵌顿滑膜唇皱襞显像的敏感性、特异性、阳性预测值、阴性预测值。②采用方差分析方法,比较21例LPEH患儿的21侧患髋、21侧健髋以及21例正常儿童42侧健髋3组之间的超声显像结果。结果超声对尸体髋关节滑膜唇皱襞嵌顿模型的诊断敏感性、特异性分别为88%、84%,阳性预测值、阴性预测值分别为79%、91%。21例LPEH患髋关节组与其它2组髋关节超声结果比较显示:①患髋组均存在关节腔内积液,髋关节内下间隙积液较前间隙明显〔(12.50±4.04)mmvs(4.35±0.8)mm,P<0.05〕,内下间隙内见嵌顿滑膜唇皱襞呈稍强回声的占位性团块,长约(15.6±5.6)mm,宽约(8.9±7.8)mm;90%嵌顿的滑膜唇皱襞内未见血流信号;②患髋组股骨头软骨厚度无明显变化(P>0.05);关节囊前层及后层厚度分别与其它2组比较,差异无统计学意义;③患髋组股骨头形态结构及关节周围软组织回声无超声影像改变;④21例LPEH患髋经非手术治疗后,超声随访嵌顿滑膜皱襞及关节腔积液消失;⑤21例LPEH健髋组髋关节各解剖层次无超声显像异常改变。结论超声检查对发现髋关节内下间隙内嵌顿的滑膜唇皱襞有较好的诊断价值;儿童LPEH患髋具有一定的超声影像学表现特征。Objective To study the ultrasonographic （US） features of labral plicae entrapment syndrome of hip （LPEH） in children and to evaluate the value of US in diagnosing LPEH. Methods （1） Twenty six LPEH models and 38 sham LPEH hips were established surgically from 32 children cadavers [15 male and 17 female, age from 2 to 8 years, mean age of （6.12±2.13） years]. US was performed on these hips double-blindly. The sensitivity, specificity, positive and negative predictive values were calculated. （2） A total of 21 children [17 male and 4 female, mean age （5.95 ± 2.67） years] with unilateral LPEH and 21 age and gender matched children with normal hips were consecutively recruited. The 21 symptomatic hips, 21 asymptomatic hips and 42 normal hips were examined by the US （ATL 5000） using the high-frequency （7.5-12 MHz） linear array transducer. Results （1） The sensitivity, specificity, positive and negative predictive values of the US for the LPEH model were 88%, 84%, 79%, and 91%, respectively. （2） Fluids in hip joints were detected in all of the 21 symptomatic hips. No fluid was detected in the asymptomatic and normal hips （less than 2mm）; The mean width of the inferomedial recess was significantly larger than that of the anterior recess （12.50 mm vs. 4.35 mm, P〈 0.05） in the 21 symptomatic hip joints; The echogenic entrapped labral plicaes were demonstrated in the inferomedial recess of the 21 symptomatic hip joints, with a length ranging from 5.3 to 25.0 mm [mean（15.63 ± 5.57） mm] and a width ranging from 4.0 to 17.0 mm [mean （8.90±7.81） mm], respectively; No color signal of blood flow was demonstrated in 90% of the 21 entrapped labral plicaes; With regard to the mean thickness of cartilage of femora head, anterior layer and posterior layer of the anterior capsule, there were no statistical significant differences between the three groups （P〉0. 05）. After manual reduction and conservative treatment, all of the entrapped labral plicae and fluids disappeared

关 键 词：尸体 儿童 髋关节 滑膜皱襞 超声 

分 类 号：R726.8[医药卫生—儿科] R445.1[医药卫生—临床医学]