儿童微小移位肱骨外髁骨折软骨铰链连续性的MRI影像学分析  

MRI imaging analysis of the continuity of cartilage hinge in children with minimally displaced lateral humeral condylar fractures

作　　者：朱彤 刘天婧[1] 王恩波[1] ZHU Tong;LIU Tian-jing;WANG En-bo(Shengjing Hospital of China Medical University,Liaoning,Shenyang,110004,China)

机构地区：[1]中国医科大学附属盛京医院小儿骨科,辽宁110004

出　　处：《中国骨与关节杂志》2021年第6期437-442,共6页Chinese Journal of Bone and Joint

摘　　要：目的分析微小移位肱骨外髁骨折 (minimally displaced lateral humeral condylar fractures,MDLHCFs) 的核磁共振成像 (magnetic resonance imaging,MRI) 影像学特点,从而探究 MDLHCFs 的软骨铰链特点并评估 MRI 对 MDLHCFs 临床诊断和治疗的指导意义。方法回顾性分析 2016 年 1 月至 2019 年 5 月我科收治的 Song2 和 Song3 型 47 例肱骨外髁骨折 (lateral humeral condylar fractures,LHCFs) 患儿资料。平均随访时间为 48 (21~99) 天。损伤后 1 周内进行 MRI 并进行分析。患儿采用保守治疗 (42 例) 或闭合复位经皮固定 (closed reduction and percutaneous pinning,CRPP) 治疗 (5 例)。2 名医生对患儿 Song2 / 3 分型进行组内及组间一致性分析。笔者在三个连续的横截面上计算肱骨远端骺软骨铰链宽度 (肱骨远端骺软骨剩余未断部分) 与骨折部位肱骨远端骺总宽度的比值[铰链宽度与总宽度比值 (ratio of hinge to total,RHT)]以判断软骨铰链是否断裂,并在连续三个冠状面判断软骨铰链是否断裂。结果组内及组间一致性分析结果显示各观察者存在一般、中等或较强的组内一致性,各观察者间存在一般或中度一致性。初始 X 线片诊断为 Song2 / 3 期骨折的 47 例患儿中,仅有 2 例 (4%) 完全骨折,MRI 上可见所有冠状面和横切面软骨铰链完全断裂。在横断面中,RHT 数据显示,横切面越低,铰链的完整程度越高。在冠状位中,约 1 / 2 的病例前切面软骨完全断裂,但几乎所有后切面软骨都有部分连接。Song2 和 Song3 各横断面 RHT 值无差异,冠状面完整性差异无统计学意义 (P>0.05)。47 例患儿中,42 例接受保守治疗,5 例接受 CRPP。2 例为完全骨折。其余 45 例不完全性骨折患儿中,41 例采用保守治疗,4 例采用 CRPP 治疗。所有患儿均骨性愈合,随访 X 线片未见骨折再移位。结论 Song2、Song3 型 LHCFs 的区分在临床中存在一定困难。此类患儿中,肱骨远端软骨未完全断裂�Objective To analyze Magnetic Resonance Imaging (MRI) manifestations of minimally displaced lateral humeral condylar fractures (MDLHCFs),investigate the characteristics of cartilage injury in such fractures,and assess the role of MRI in the diagnosis and planning of MDLHCFs treatment.Methods A retrospective analysis of 47 patients with Song2 and Song3 lateral humeral condylar fractures (LHCFs) was conducted from January 2016 to May 2019.All were treated at Department of Pediatric Orthopaedics,Shengjing Hospital of China Medical University.The average duration of follow-up was 48 days (range:21-99 days).MRI was applied within one week of injury and analyzed.Patients were treated conservatively (42 patients) or by closed reduction and percutaneous pinning (CRPP) (5 patients).Inter-observer and intra-observer reliability analysis was performed for the Song2 / 3 typing of patients by two doctors.The ratio of the width of the cartilage hinge (the remaining unbroken part of the distal humeral epiphyseal cartilage) to the total width of the distal humeral epiphysis at fracture site(Ratio of Hinge to Total,RHT) in three consecutive cross sections was calculated to determine if the cartilage hinge was broken,as well as the coronal plane of three sections.Results Reliability analysis revealed fair or moderate agreement between the two observers,and the two observers showed fair,moderate or good consistency.Among the 47 patients diagnosed as Song stage 2 / 3 fracture on the initial radiographs,only 2 patients (3%) had a complete fracture with complete disruption of the cartilage hinge seen on the MRI.In the cross sections,RHT data showed that lower section always indicated higher extent of integrity.The anterior cartilage was completely broken in about half the cases,but almost all posterior cartilage had some parts in connection.There were no significant differences between Song stage 2 and 3 concerning the RHT value in any cross section,as well as the completeness in coronal sections(P>0.05).Of the 47 patients treated,42

关 键 词：肱骨骨折 磁共振成像 骨折闭合复位 保守治疗 

分 类 号：R683.4[医药卫生—骨科学]