高频超声诊断小儿桡骨远端骨折术后骨痂质量的价值探讨  

The value of high-frequency ultrasound in diagnosing postoperative callus quality in children with distal radius fractures

作　　者：冯澜 印飞 信天游 顾珺 王军 林伟枫 芮永军 Feng Lan;Yin Fei;Xin Tianyou;Gu Jun;Wang Jun;Lin Weifeng;Rui Yongjun(Department of Functional Section,Wuxi Ninth People's Hospital,Wuxi 214062,China;Department of Orthopedics,Wuxi Ninth People's Hospital,Wuxi 214062,China)

机构地区：[1]无锡市第九人民医院功能科,无锡214062 [2]无锡市第九人民医院骨科,无锡214062

出　　处：《中华手外科杂志》2024年第4期366-370,共5页Chinese Journal of Hand Surgery

摘　　要：目的探讨高频超声在诊断小儿桡骨远端骨折术后骨痂愈合质量中的可行性与临床意义.方法采用彩色多普勒超声与剪切波弹性成像观察30例小儿桡骨远端骨折患者内固定术后第2、4、8、12周骨痂形成的声像特征,采集骨痂处血管阻力指数(resistance index,RI)、剪切波速度及杨氏模量,并与X线片进行对比分析.结果30例患者均完成随访,术后第1周骨折断端可见血肿,无血流信号,X线片未见骨痂.术后第2周,所有患者骨折断端处均可见骨痂回声,灰阶超声提示骨痂横切面3.0mm×0.7mm~4.0mm×1.0mm,骨折部位可见血流信号,RI为0.51~0.55,骨痂剪切波速度平均2.58 m/s,杨氏模量平均20.8 kPa,RUSS得分1~4分.术后第4周,骨折断端处灰阶超声提示骨痂横切面1.7 mm×1.1 mm~4.0mm×2.3 mm,骨折部位血流信号强,RI为0.51~0.57,骨痂剪切波速度平均3.04 m/s,杨氏模量平均28.6 kPa,X线片显示骨痂开始增厚,RUSS得分5~7分.术后第8周,X线片提示骨痂愈合良好,灰阶超声提示骨痂横切面1.8 mm×2.1 mm~9.9mm×2.1 mm,骨痂处血流信号较前减少,RI为0.55~0.58,骨痂剪切波速度平均4.58 m/s,杨氏模量平均52.5 kPa,RUSS得分6~8分.术后第12周,灰阶超声骨痂横切面2.6 mm×1.2 mm~10.7 mm×1.8 mm,骨痂处无血流信号,骨痂剪切波速度平均4.83m/s,杨氏模量平均70.9 kPa,RUSS得分均为8分.结论应用高频超声能有效监测小儿桡骨远端骨折端骨痂愈合的过程及其血运变化,能定量分析各阶段骨痂愈合质量,可为临床早期预测骨折愈合的趋势提供有效参考,利于早期预警、干预以降低骨折延迟愈合及不愈合等情况的发生.Objective To explore the feasibility and clinical significance of high-frequency ultrasound in diagnosing the quality of postoperative callus healing in children with distal radius fractures.Methods Color Doppler ultrasound and shear wave elastography were used to observe the acoustic characteristics of callus formation in 30 children with distal radius fractures after internal fixation surgery at 2,4,8,and 12 weeks.The vascular resistance index(RI),shear wave velocity,and Young's modulus at the callus site were collected and compared with X-ray images.Results All 30 patients completed follow-up,and in the first week after surgery,a hematoma was visible at the fracture site without blood flow signal,and no bone callus was observed on X-ray films.At the second week after surgery,bone callus echoes were visible at the fracture ends of all patients.Gray scale ultrasound indicated a transverse section of 3.0 mm×0.7 mm to 4.0 mm×1.0 mm of the callus,and blood flow signals were visible at the fracture site.The RI was 0.51 to 0.55,with an average shear wave velocity of 2.58 m/s and a mean Young's modulus of 20.8 kPa.The RUSS score was 1 to 4 points.At the 4th week after surgery,grayscale ultrasound at the fracture site indicated a transverse section of 1.7 mm×1.1 mm to 4.0 mm×2.3 mm of the callus.The blood flow signal at the fracture site was strong,with RI ranging from 0.51 to 0.57.The average shear wave velocity of the callus was 3.04 m/s,and the Young's modulus was 28.6 kPa.The X-ray showed that the callus began to thicken,and the RUSS score was 5 to 7 points.At the 8th week after surgery,X-ray showed good healing of the callus,while grayscale ultrasound indicated a transverse section of 1.8 mm×2.1 mm to 9.9 mm×2.1 mm of the callus.The blood flow signal at the callus site decreased compared to before,with an RI of 0.55 to 0.58,an average shear wave velocity of 4.58 m/s,an average Young's modulus of 52.5 kPa,and a RUSS score of 6 to 8 points.At the 12th week after surgery,the transverse section of the callus on

关 键 词：桡骨骨折 超声检查 多普勒 彩色 骨痂 骨折愈合 剪切波弹性成像 

分 类 号：R726.8[医药卫生—儿科]