影响儿童肘关节隐匿性骨折诊断的危险因素分析  

Analysis of risk factors affecting diagnosis of occult fractures of elbowjoint in children

作　　者：叶萍萍 段红波[1] 邵国庆[1] 刘珊珊 方士波 赵华国[2] YE Pingping;DUAN Hongbo;SHAO Guoqing;LIU Shanshan;FANG Shibo;ZHAO huaguo(Department of Ultrasound,Ningbo No.6 Hospital,Ningbo,Zhejiang 315040,China;不详)

机构地区：[1]宁波市第六医院超声科,浙江315040 [2]宁波市第六医院小儿骨科,浙江315040

出　　处：《中国骨与关节损伤杂志》2023年第9期926-931,共6页Chinese Journal of Bone and Joint Injury

摘　　要：目的 基于儿童肘关节隐匿性骨折的超声图像特征、临床特征,筛选出影响儿童肘关节隐匿性骨折诊断的独立危险因素。方法 纳入自2020-01-2022-12于宁波市第六医院就诊的97例儿童肘关节损伤,收集患者的超声图像特征、临床特征,进行单因素Logistic回归分析,将P值<0.2的指标纳入多因素Logistic回归分析,筛选出影响肘关节隐匿性骨折诊断准确性的独立危险因素。结果 根据随访期间X线片检查结果,非隐匿性骨折77例(77/97),隐匿性骨折20例(20/97),单因素分析结果显示患者的超声征象积脂血症、骨皮质回声改变、肌肉损伤,以及首次X线脂肪垫征、外伤史、淤青、压痛及活动受限这8个指标的P值<0.2,将上述指标纳入多因素Logistic分析,结果显示超声征象积脂血症(OR=0.197,95%CI为0.043~0.573)和外伤史(OR=0.152,95%CI为0.019~0.767)是影响肘关节隐匿性骨折诊断准确性的独立危险因素(P<0.05)。结论 影响儿童隐匿性骨折诊断的独立危险因素是超声征象积脂血症和外伤史,这2项独立因素可提高儿童肘关节隐匿性骨折诊断准确率,减小临床漏诊风险,为临床提供有效参考。Objective To screen out the independent risk factors affecting the diagnosis of occult elbow fractures in children based on the ultrasound image features and clinical features of occult fractures of the elbow joint in children.Methods Nine-ty-seven cases of children with elbow joint injuries treated at Ningbo Sixth Hospital from January 2020 to December 2022 were enrolled.The ultrasound image characteristics and clinical features of these patients were collected.Single-factor logistic re-gression analysis was conducted,and indicators with a P-value<0.2 were included in the subsequent multivariable logistic re-gression analysis.This analysis aimed to identify the independent risk factors affecting the diagnostic accuracy of occult frac-tures of the elbow joint.Results During the follow-up period,X-ray examination results showed that 77 out of 97 cases had non-occult fractures,while 20 cases(20/97)had occult fractures.The findings from the univariate analysis indicated that lipe-mia and bone cortical echo changes,muscle injury,the presence of the first X-ray fat pad sign,trauma history,bruising,tender-ness,and activity limitation were potential risk factors associated with occult fractures.The p-values for all eight indicators were<0.2,leading to their inclusion in the multivariate logistic analysis.The results of the multivariate analysis revealed that the ultrasound sign was lipemia(OR=0.197,95%CI 0.043-0.573)and trauma history(OR=0.152,95%CI 0.019-0.767)were in-dependent risk factors affecting the diagnostic accuracy of occult fractures of the elbow(P<0.05).Conclusion The diagnosis of occult fractures in children is influenced by two independent risk factors:ultrasonographic signs of lipemia and history of trau-ma.These factors have the potential to enhance the accuracy of diagnosing occult fractures in the elbow joint of children,mini-mize the risk of clinical misdiagnosis,and provide effective reference for clinical practice.

关 键 词：儿童肘关节骨折 隐匿性骨折 超声 危险因素 

分 类 号：R683.4[医药卫生—骨科学]