儿童肘关节损伤术中X线造影技术专家共识  

Expert consensus on X-ray arthrography techniques for pediatric elbow injuries

作　　者：中国医师协会骨科医师分会小儿骨科专业委员会 中国医师协会骨科医师分会小儿骨科肢体矫形学组 颉强 张中礼[3] 林凤飞(指导)[4] 杨建平(指导)[3] 陆清达 严亚波 Pediatric Orthopaedic Committee of Chinese Association of Orthopaedic Surgeons;Pediatric Orthopaedic Limb Deformity Correction Group of Chinese Association of Orthopaedic Surgeons;JIE Qiang;ZHANG Zhongli

机构地区：[1]不详 [2]西安交通大学附属红会医院 [3]天津市天津医院 [4]福州市第二医院 [5]空军军医大学西京医院

出　　处：《中华骨与关节外科杂志》2024年第8期678-685,共8页Chinese Journal of Bone and Joint Surgery

摘　　要：肘关节损伤是儿童最常见的损伤之一。儿童肘关节解剖结构的特殊性在于软骨组织多,常规X线检查无法使关节软骨充分显影,进而造成阅片困难。儿童肘关节次级骨化中心出现的时间存在个体差异,导致骨科医师在评估肘关节损伤情况时出现差异,增加了误诊、漏诊的风险,并影响治疗结果的精确评价。因此,建立早期、精准、有效的评估方法对儿童肘关节损伤的诊断和治疗至关重要。关节造影技术能够有效补充常规X线检查在软骨结构显影方面的不足,使其在儿童肘关节损伤的诊断和治疗评价中逐渐得到广泛应用,使诊断的准确性和治疗效果得以提高。尽管肘关节造影技术运用广泛,但不同地区和不同操作者在进行肘关节造影时的操作标准及操作习惯存在显著差异,严重影响了造影效果的统一性和可靠性。当前,亟待建立一套标准化、高效的肘关节造影技术流程。因此,为了使小儿骨科医师在进行肘关节造影时获得一致和可靠的成像结果、减少不必要的重复操作,并避免潜在并发症的发生,现综合文献回顾及调查研究形成《儿童肘关节损伤术中X线造影技术专家共识》。本共识系统总结了儿童肘关节周围骨折的诊疗难点,详细阐述了术中X线造影技术在解决这些问题中的应用,以临床问题为导向,归纳出7个关键问题:①肘关节术中造影的概念;②肘关节术中X线造影的适应证;③肘关节术中X线造影的常用方法;④造影剂的选择;⑤造影剂的安全性;⑥造影剂使用前是否进行过敏试验;⑦造影剂是否需要稀释。本共识旨在指导、规范肘关节造影技术在儿童肘关节损伤中的临床应用,以推动肘关节造影技术在骨科学中的普及和发展。Elbow injuries are among the most common injuries in children.The unique anatomical features of the pediatric elbows,characterized by abundant cartilaginous tissue,make it difficult to adequately visualize the articular cartilage on conventional X-rays,leading to challenges in radiographic interpretation.Variations in the timing of secondary ossification centers in pediatric elbow joints lead to differences in the assessment of elbow injuries by orthopedic surgeons,increasing the risk of misdiagnosis and missed diagnosis,and may finally affect the accurate evaluation of treatment outcomes.Consequently,establishing an early,accurate,and effective assessment method is vital for the diagnosis and treatment of pediatric elbow injuries.Arthrography effectively supplements the limitations of conventional X-ray imaging in cartilage.Therefore,this technique has gradually gained popularity for diagnosing and evaluating the treatment outcomes of pediatric elbow injuries,aiming to improve diagnostic accuracy and treatment outcomes.Despite the widespread use of elbow joint arthrography,there are significant differences in operation standards and habits among different regions and operators,which severely affects the uniformity and reliability of the arthrographic effects.At present,there is an urgent need to establish a standardized and effective elbow arthrography technique.Therefore,to ensure consistent and reliable imaging results during elbow joint arthrography,reduce unnecessary repeated procedures,and minimize complications,the"Expert Consensus on X-ray Angiography Techniques in Pediatric Elbow Injuries"was developed based on literature review and survey research.This consensus systematically summarizes the challenges in the diagnosis and treatment of pediatric fractures around the elbow and elaborates in detail on the application of intraoperative X-ray angiography in addressing these issues.Guided by clinical problems,seven key issues are identified:①the concept of intraoperative elbow arthrography;②indications f

关 键 词：肘关节损伤 关节造影术 儿童 造影剂 X线 

分 类 号：R683[医药卫生—骨科学]