儿童长骨骨折治疗后骨痂形成评估新方法的临床应用研究

Clinical application of new evaluation method to callus formation after treatment of long bone fractures in children

摘要:

目的分析超声波与射线对儿童长骨骨折后骨痂形成成像的联系，探讨超声波评价儿童长骨骨折后骨痂形成的有效性和可行性。方法该研究纳入50 例手臂、前臂、大腿以及小腿长骨骨折的儿童进行前瞻性研究。其中男孩31 例、女孩19 例，平均年龄分别为11 岁和9 岁。分别对56 个骨折骨和56 个对应的健侧骨进行检查。采用Philips iU22 相机配备17-5-MHz线性探针和MSK Superficial 程序进行超声诊断。在超声检查的同时对骨痂进行测量。利用能量多普勒（Power Doppler）对骨痂的血管进行可视化处理并测定血管阻力指数（RI）。在健侧肢体的相应区域进行同样的检测。将超声结果与X 射线测量结果以及骨痂的客观质量评价进行比较。结果所有50 例患者均顺利完成研究。在这两个组中，无移位骨折均是最常见骨折；需复位骨折与骨膜下骨折的发生率相近；与之相反，女孩骨折碎片轻微移位的发生率是男孩的3 倍多。统计分析表明，超声波与X射线对骨痂的长度和宽度测量结果之间的差异无统计学意义。此外，初步结果显示骨痂的血管化程度高于正常骨膜。结论超声波在评价儿童长骨骨折后骨痂形成方面与X 射线检查同样有效可靠，具有免受电离辐射损伤的优点。

Abstract:

Objective To analyze the correlation of ultrasound and radiographs with imaging of callus formation after fractures of long bones in children and to analyze the correlation of vascular resistance index (RI) and the degree of callus vascularization with a subjective radiological assessment of the bone union quality. Methods The prospective study was planned to qualify 50 children treated for long bones fractures of the arms, forearms, thighs or lower legs. The participants included 31 boys and 19 girls, whose average age at injury was 11 and 9 years respectively. Totally 56 fractured bones and 56 corresponding contralateral healthy bones were examined. Ultrasound diagnosis was carried out using a Philips iU22 camera equipped with a linear probe with 17-5-MHz resolution and MSK Superficial program. During ultrasound examination the callus was measured. Using the Power Doppler callus vascularity was visualized and RI was measured. The same measurements were made within the corresponding area of the healthy limb. The results obtained by ultrasound were compared with radiograph measurements and with the subjective assessment of the callus quality. Results Preliminary results were developed on a group of 50 patients. In both groups the fractures without displacement were the most frequent fractures. A similar frequency was observed in the fractures requiring reduction and subperiosteal fractures. In contrast, the fractures with a slight displacement of the fragments occurred 3 times more often in girls. Statistical analysis showed there was no statistical difference in the length or width of the callus measured by ultrasound and by X-rays. Moreover, preliminary results showed the degree of vascularization of the callus was significantly higher than that of the healthy periosteum. Conclusions Preliminary results indicate the high efficacy of ultrasonography in the evaluation of callus formation after fractures of long bones in children and the possibility of its alternative to X-ray examination.