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中华医学超声杂志(电子版) ›› 2023, Vol. 20 ›› Issue (08) : 795 -800. doi: 10.3877/cma.j.issn.1672-6448.2023.08.002

小儿超声影像学

超声对儿童髋关节暂时性滑膜炎的诊断价值
周钰菡, 肖欢(), 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷   
  1. 400014 重庆医科大学附属儿童医院超声科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病研究教育部重点实验室 儿科学重庆市重点实验室
    400014 重庆医科大学附属儿童医院风湿免疫科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病研究教育部重点实验室 儿科学重庆市重点实验室
  • 收稿日期:2022-08-12 出版日期:2023-08-01
  • 通信作者: 肖欢
  • 基金资助:
    重庆市2021科卫联合医学科研项目(2021MSXM297); 重庆医科大学未来医学青年创新团队支持计划

Diagnostic value of ultrasound in children with temporary hip synovitis

Yuhan Zhou, Huan Xiao(), Chunjiang Yang, Juan Zhou, Lirong Zhu, Juan Xu, Fangting Mou   

  1. National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Department of Ultrasonography, Children's Hospital Affiliated to Chongqing Medical University, Chongqing 400014, China
    Department of Rheumatology and Immunology, Children's Hospital Affiliated to Chongqing Medical University, Chongqing 400014, China
  • Received:2022-08-12 Published:2023-08-01
  • Corresponding author: Huan Xiao
引用本文:

周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志(电子版), 2023, 20(08): 795-800.

Yuhan Zhou, Huan Xiao, Chunjiang Yang, Juan Zhou, Lirong Zhu, Juan Xu, Fangting Mou. Diagnostic value of ultrasound in children with temporary hip synovitis[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 795-800.

目的

对比健康儿童与髋关节暂时性滑膜炎患儿的超声表现,探讨髋关节暂时性滑膜炎有效的超声诊断指标及其诊断价值。

方法

回顾性收集2020年1月至2022年7月于重庆医科大学附属儿童医院就诊的320例健康儿童及200例髋关节暂时性滑膜炎患儿,均进行髋关节超声检查。分析滑膜炎患儿与健康对照儿童的髋关节颈前间隙宽度、关节腔积液、关节囊壁厚度、关节轮廓、关节囊血供等超声指标。绘制ROC曲线,分析超声指标独立及联合对髋关节暂时性滑膜炎的诊断效能。

结果

3.7%(24/640)的健康儿童髋关节囊可呈现凸起状态;10%(64/640)的健康儿童关节腔内可出现少量生理性积液;颈前间隙平均值(0.55±0.10)cm;关节囊前、后壁均值分别为(0.25±0.07)、(0.25±0.06)cm,其差异无统计学意义(P>0.05)。200例患儿共261髋受累,78.4%(228/261)的滑膜炎患儿关节囊呈现凸起轮廓;261个患侧髋关节腔内均可见积液,平均值(0.84±0.21)cm;患侧颈前间隙平均值(0.89±0.21)cm;关节囊壁厚度(0.25±0.47)cm,与健康正常组关节囊前、后壁比较,差异均无统计学意义(P>0.05);健侧与患侧关节囊血供差异无统计学意义(P>0.05)。颈前间隙、关节腔积液、双侧颈前间隙之差、双侧关节腔积液之差及关节囊轮廓5项超声指标中,双侧颈前间隙之差诊断髋关节暂时性滑膜炎的ROC曲线下面积为0.98,大于其他超声指标,其最佳截断值为0.1 cm。联合指标中,颈前间隙>0.66 cm+关节腔积液量之差>0.16 cm的诊断效能最佳,ROC曲线下面积为0.97。

结论

滑膜炎患儿关节囊及滑膜并未显著增厚,血供也未见明显增多;双侧颈前间隙之差及颈前间隙联合双侧关节腔积液之差对髋关节暂时性滑膜炎具有良好的诊断效能,为超声诊断髋关节暂时性滑膜炎提供了依据。

Objective

To compare the ultrasonic findings of healthy children and children with temporary hip synovitis, and to investigate the effective ultrasonic diagnostic indices and their diagnostic value in temporary hip synovitis.

Methods

From January 2020 to July 2022, 320 healthy children and 200 children with temporary hip synovitis were recruited from the Chongqing Medical University Children's Hospital. The breadth of the anterior femoral neck space (ultrasonoimagedata joint space, UJS), joint effusion, joint capsule wall thickness, joint shape, and blood supply of the joint capsule were measured. The diagnostic efficacy of ultrasonic markers, alone or in combination, in hip transient synovitis was examined by receiver operating characteristic (ROC) curve analysis.

Results

Approximately 3.7% of healthy children (24/640) had a protruding hip capsule, and 10% (64/640) had a small amount of physiologic fluid accumulation in the joint cavity. The average UJS was (0.55±0.10) cm. The mean thickness of the anterior and posterior walls of the articular capsule was (0.25±0.07) cm and (0.25±0.06) cm, respectively, with no statistical difference (P>0.05). The majority (78.4%, 228/261) of children with synovitis presented a convex articular capsule profile. Fluid accumulation was observed in the lumen of 261 affected hip joints, with an average value of (0.84±0.21) cm. The UJS on the affected side was (0.89±0.21) cm. The wall thickness of the articular capsule was (0.25±0.47) cm, and there was no significant difference in the thickness of the anterior and posterior walls of the articular capsule between children with temporary hip synovitis and the healthy group (P>0.05). There was no significant difference in blood supply between the healthy side and affected side (P>0.05). Among the five ultrasonic indexes (UJS, articular effusion, bilateral UJS difference, bilateral articular effusion difference, and articular capsule contour), the area under the ROC curve of bilateral UJS difference was 0.98, which was larger than that of the other ultrasonic indexes, and the best cut-off value was 0.1 cm. Among the joint indexes, the diagnostic efficiency of UJS >0.66 cm +articular effusion difference >0.16 cm was the best, and the area under the ROC curve was 0.97.

Conclusion

The articular capsule and synovial membrane in children with synovitis do not significantly thicken, and the blood supply does not significantly increase. The difference of bilateral UJS and the difference of UJS combined with bilateral joint effusion have good diagnostic efficacy for temporary hip joint synovitis, which provides a basis for ultrasound diagnosis of temporary hip joint synovitis..

图1 健康儿童髋关节超声表现。图a示关节囊形态凹陷,腔内无积液,关节囊前后壁回声不一致,前壁回声增强(黄色双箭头为关节囊前壁厚度,红色双箭头为关节囊后壁厚度,蓝色双箭头为股骨颈颈前间隙);图b示关节腔内少量积液(双箭头所示),内可见细密点状强回声;图c示关节囊平直(箭头所示);图d示关节囊形态凸起(箭头所示)
图2 髋关节暂时性滑膜炎患儿的健侧与患侧关节囊血流信号超声图像。图a示健侧关节囊血流计数为1条;图b为患侧关节囊血流计数为1条
图3 患儿,男性,5岁,关节疼痛跛行1 d就诊。超声检查示股骨颈前方见圆形囊性结构滑膜假性憩室(箭头所示)
图4 患儿,男性,7岁,关节疼痛跛行2 d就诊。超声检查示髋关节腔积液,腔内可见条带状回声穿过
图5 超声各指标独立或联合诊断髋关节暂时性滑膜炎的ROC曲线
表1 超声各项独立指标及多指标联合对TS的ROC曲线诊断效能分析
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