泪滴影与脂肪垫征在儿童隐匿性肱骨髁上骨折中早期诊断价值  

The value of teardrop shadow and fat pad sign in early diagnosing occult humeral supracondylar fractures in children

作　　者：刘远忠 吴剑平 黎艺强 李敬春 徐宏文 LIU Yuan-zhong;WU Jian-ping;LI Yi-qiang;LI Jing-chun;XU Hong-wen(Dept of Orthopaedics,Guangzhou Women and Children′s Medical Center,Guangzhou,Guangdong 510623,China)

机构地区：[1]广州市妇女儿童医疗中心骨科,广东广州510623

出　　处：《临床骨科杂志》2025年第1期78-80,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨泪滴影与脂肪垫征在儿童隐匿性肱骨髁上骨折中早期诊断价值。方法将33例肘部损伤患儿根据有无隐匿性肱骨髁上骨折证据分为有骨折组(27例)和无骨折组(6例),在X线侧位片上评估泪滴影、脂肪垫征和新生骨形成情况。结果治疗前侧位X线片显示,有骨折组23例(23/26)、无骨折组4例(4/6)前脂肪垫征阳性,有骨折组23例(23/26)、无骨折组4例(4/6)后脂肪垫征阳性,前、后脂肪垫征阳性发生率两组比较差异均无统计学意义(P>0.05);有骨折组24例(24/27)、无骨折组2例(2/6)泪滴影变形,泪滴影变形发生率有骨折组高于无骨折组(P<0.05)。Spearman相关性分析显示,泪滴影变形与隐匿性肱骨髁上骨折呈正相关关系(P=0.002),而前、后脂肪垫征阳性与隐匿性肱骨髁上骨折无明显相关性(P=0.302)。结论相较于前、后脂肪垫征阳性,泪滴影变形在诊断隐匿性肱骨髁上骨折中具有更高的准确性、敏感性、特异性及预测性,且与隐匿性肱骨髁上骨折呈正相关关系,可作为早期诊断儿童隐匿性肱骨髁上骨折的重要标准,而前、后脂肪垫征阳性与隐匿性肱骨髁上骨折无明显相关性,仅作为肘部外伤时诊断的参考指标。Objective To investigate the value of teardrop shadow and fat pad sign in early diagnosis of occult humeral supracondylar fracture in children.Methods The 33 children with elbow injuries were divided into fracture group(27 cases)and non-fracture group(6 cases)according to whether existing the evidence of occult humeral supracondylar fracture.Teardrop shadow,fat pad sign and new bone formation were evaluated on lateral X-ray film.Results The lateral X-film before treatment showed that the anterior(posterior)fat pad sign was positive in 23 patients(23/26)of the fracture group and 4 patients(4/6)of the non-fracture group.The positive incidence of anterior-posterior fat pad sign had no statistical significance between the two groups(P>0.05).Teardrop shadow deformation occurred in 24 cases(24/27)of the fracture group and 2 cases(2/6)in the non-fracture group,and the incidence of teardrop shadow deformation in the fracture group was higher than that of the non-fracture group(P<0.05).Spearman correlation analysis showed that teardrop shadow deformation was positively correlated with occult humeral supracondylar fracture(P=0.002),while positive anterior-posterior fat pad sign was not significantly correlated with occult humeral supracondylar fracture(P=0.302).Conclusions Compared with positive anterior-posterior fat pad signs,teardrop shadow deformation has higher accuracy,sensitivity,specificity and predictability in the diagnosis of occult humeral supracondylar fracture,and which is positively correlated with occult humeral supracondylar fracture,and can be used as an important criterion for early diagnosis of occult humeral supracondylar fracture in children.While there is no significant correlation between positive anterior-posterior fat pad sign and occult supracondylar fracture of humerus,and it is only used as a reference index in diagnosis of elbow trauma.

关 键 词：儿童 隐匿性肱骨髁上骨折 泪滴影 脂肪垫征 早期诊断 

分 类 号：R726.834.1[医药卫生—儿科] R445.4[医药卫生—临床医学]