婴幼儿股骨头微循环的超微血管成像特征及临床意义  

Superb microvascular imaging characteristics and clinical significance of femoral head microcirculation in infants

作　　者：林立军 伍兴 夏敬冬 王思 王腾 胡平波 沈先涛 Lin Lijun;Wu Xing;Xia Jingdong;Wang Si;Wang Teng;Hu Pingbo;Shen Xiantao(School of Medicine,Jianghan University,Wuhan 430056,China;Department of Orthopedics,Municipal Children’s Hospital,Wuhan 430014,China)

机构地区：[1]江汉大学医学部,武汉430056 [2]武汉儿童医院骨科,武汉430014

出　　处：《临床小儿外科杂志》2024年第7期653-658,共6页Journal of Clinical Pediatric Surgery

基　　金：湖北省重点研发计划项目(2021BCA140);湖北省自然科学基金项目(2022CFB460)。

摘　　要：目的探索超微血管成像评估婴幼儿股骨头血运的可行性及其图像特征。方法本研究为回顾性研究, 选取2023年4月在武汉儿童医院骨科行健康筛查的18例婴儿(男11例、女7例)作为研究对象, 日龄(51.1±38.7)d, 均在安静状态下行髋关节超声检查。从髋关节外侧横切面与纵切面两个方向上进行检查, 先使用灰度超声观察股骨头的解剖特点, 然后采用超微血管成像显示股骨头内血流情况, 测量血管收缩期峰值血流速度。结果 18例婴儿股骨头横切面灰度超声图像均可见明显交替低回声与条纹回声, 条纹向股骨头中心汇聚, 纵切面灰度超声图像上可见股骨头与大转子中的点状或条纹回声。在股骨头的超微血管成像图中, 均可显示股骨头内血流, 横切面上观察到血流向骨化中心汇聚;在纵切面上观察到股骨头血供主要有两个来源:一处来自股骨干骺端, 穿越骺板, 垂直于骺板走行在股骨头内;另一处来自旋股内侧动脉后上支, 其分支略平行于骺板走行在股骨头内。除1例婴儿检查时受到杂波干扰外, 余17例婴儿均可测得旋股内侧动脉后上支收缩期峰值血流速度, 为(10.9±4.3)cm/s。比较男性、女性之间旋股内侧动脉后上支收缩期峰值血流速度, 差异无统计学意义[(10.63±4.56)cm/s比(11.21±4.17)cm/s, P=0.791]。旋股内侧动脉后上支收缩期峰值血流速度与体重呈显著正相关(r=0.531, P=0.028)、与日龄呈显著正相关(r=0.775, P<0.001)。进行线性回归分析, 旋股内侧动脉后上支收缩期峰值血流速度与日龄、体重的线性拟合程度均较高[旋股内侧动脉后上支收缩期峰值血流速度(cm/s)=6.279+0.100×日龄(d), R^(2)=0.600, P<0.01];旋股内侧动脉后上支收缩期峰值血流速度(cm/s)=5.215+1.704×体重(kg), R^(2)=0.282, P<0.05。结论本研究初步证明了超微血管成像技术可用于评估婴儿股骨头的血运。Objective To explore the feasibility and image characteristics of superb microvascular imaging(SMI)for assessing femoral head blood flow in infants and toddlers.Methods There were 11 boys and 7 girls with an age range of(51.1±38.7)day.In April 2023,anatomical characteristics of femoral head were observed by gray-scale ultrasonography in a quiet state.And SMI was utilized for measuring peak systolic blood flow velocity of vessels.Results Alternating hypoechogenicity and striated echogenicity appeared on gray-scale ultrasonic images of transverse section of femoral head.There was converging to the center of femoral head.Punctate or striated echoes in femoral head and greater trochanter were noted on longitudinal scans.Blood flow in femoral head converged to ossification center on transverse scan.Blood supply to femoral head on longitudinal scan came from two major sources:one from femoral metaphysis,crossing physeal plate,running perpendicular to physeal plate in femoral head;and the other from posterosuperior branch of pinning medial femoral artery with branches slightly parallel to physeal plate in femoral head.Peak systolic velocity of posterosuperior branch of medial femoral artery was(10.9±4.3)cm/s in 17 infants except one case was disturbed by clutter during examination.No significant difference existed in peak systolic blood flow velocity between males and females in posterosuperior branch of medial circumflex femoral(MCF)artery(P=0.791).Peak systolic velocity of posterosuperior branch of MCF artery was significantly correlated positively with body weight(r=0.531,P=0.028)and age(r=0.775,P<0.001).Linear regression analysis was performed,and peak systolic blood flow velocity of posterior superior branch of MCF artery was linearly fitted with age and body weight[peak systolic blood flow velocity of posterior superior branch of MCF artery(cm/s)=6.279+0.100×age(days),R^(2)=0.600,P<0.01);peak systolic blood flow velocity of posterior superior branch of MCF artery(cm/s)=5.215+1.704×body weight(kg),R^(2)=0.282,P

关 键 词：股骨头血运 超微血管成像 外科手术 儿童 

分 类 号：R68[医药卫生—骨科学]