儿童肱骨远端骨骺损伤X线诊断与鉴别诊断(附182例分析)

骨骺损伤包括骨骺分离、骨骺和骺软骨骨折。骨骺由骺软骨和骨化中心组成,而软骨在X线平片上不能显示,X线诊断受到限制。因而有必要熟悉软骨损伤间接征象,以判断损伤的部位、范围和错位程度,防止诊断错误、处理不当而造成畸形和功能障碍。我们把10年来182例15岁以下儿童肱骨远端骨骺损伤的X线资料进行分析,探讨其X线表现,鉴别诊断及预后评估。     

骨骺损伤的X线平片诊断——附90例分析

目的探讨骨骺损伤的分型和各型损伤的X线表现。方法采用Salter-Harris分类法对90例（93个）骨骺损伤进行回顾性分析，重点观察各型的发生部位和X线表现。结果S-HⅡ型、Ⅳ型和Ⅰ型最常见，占93个骨骺损伤的94．2％（88个）。结论X线平片是诊断骨骺损伤的最佳方法，X线表现为骨骺和骨干的对应位置发生错位和骨骺线增宽，轻微移位和／或骺线增宽易被忽略，须摄健侧对比观察。     

半肢骨骺发育异常10例

本文报告了10例半肢骨骺发育异常的临床和X线表现,此病常见于男性,好发于下肢骨的内侧,尤以距骨最多见。主要X线表现为下肢的一个或几个骨骺软骨偏心性过度生长。     

儿童肘关节创伤的X线表现分析

目的分析儿童肘关节创伤的X线表现，以提高X线诊断水平。方法分析125例儿童肘关节创伤的X线表现，其中全部病例均摄肘关节正侧位片。结果125例中，81例创伤发生于左侧，44例发生于右侧，其中肱骨髁上骨折49例，肱骨外髁骨骺骨折28例，肱骨远端全骨骺分离6例，肱骨内上髁骨骺分离18例，尺骨鹰嘴骨折7例，尺骨近端骨折合并桡骨小头脱位6例，单纯尺骨近端骨折2例，桡骨小头骨骺分离或骨折5例，肘关节后脱位2例，桡骨小头半脱位2例。结论熟悉儿童肘关节的解剖特点，依靠直接和间接征象，判断X线片上不显影部分的损伤，可提高儿童肘关节创伤的X线诊断水平。     

外伤性骨骺早闭的X线诊断(附12例报告)

目的　提高儿童骨骺早闭的诊断水平。方法　回顾性分析 12例骨骺早闭的X线表现。结果　所有患儿均有不同程度的肢体畸形 ,X线表现为患肢内 /外翻畸形 ,骺板软骨低密度连续线凹凸不平并局部中断 ,其间可见骨小梁通过 ,骨骺与干骺端不同程度融合。结论　X线可准确地显示骨骺早闭的部位、程度和范围 ,为临床提供准确的影像诊断依据。     

26例肢体延长术X线观察

本文报告26例脊髓灰质炎后遗症致下肢短缩,应用胫骨干骺端截骨延长和胫骨骨骺牵开延长术的X线表现。年龄11～26岁,其中干骺端截骨延长19例,骨骺牵开延长6例,平均延长长度为5cm。X线主要观察延长区是否被牵开、延长长度、各期的骨痂形成、有无并发症等。     

儿童肱骨远端骨骺损伤的X线诊断和预后评价

目的:探讨、总结儿童肱骨远侧骨骺损伤的X线诊断和预后评价。材料与方法:整理216例14岁以下儿童肱骨远端骨骺损伤的X线资料,进行回顾性分析总结,按肱骨小头骨骺分离、肱骨内髁骨折及远端全骨骺分离分组,对各组的骨折机制及X线表现进行分析及随访观察。结果:远端全骺分离25例,占11.6%。肱骨小头骨骺分离134例,占62%,其中96例,愈合后出现不同程度的关节畸形;肱骨内上髁骨折57例,占26.4%。结论:骨骺损伤导致血供障碍是造成畸形愈合的主要原因,准确的X线诊断,满意的复位,及时合理的治疗,对防止严重畸形的发生会起到积极的作用。     

外伤性骨骺早闭的X线诊断

目的提高儿童骨骺早闭的诊断水平。方法回顾性分析12例骨骺早闭的X线表现。结果所有患儿均有不同程度的肢体畸形，X线表现为患肢内／外翻畸形，骺板软骨低密度连续线凹凸不平并局部中断，其间可见骨小梁通过，骨骺与干骺端不同程度融合。结论X线可准确地显示骨骺早闭的部位、程度和范围，为临床提供准确的影像诊断依据。     

MRI在儿童肘关节骨骺损伤诊断中的应用价值

目的 探讨MRI在儿童肘关节骨骺损伤诊断中的价值.方法 选取2014年2月至2015年8月于郑州市骨科医院就诊的23例儿童急性肘关节损伤患者,所有患儿伤后首次均行肘关节正侧位X线及MRI检查.结果 X线检查明确骨折6例,"八"字征阳性5例,仅软组织肿胀4例,未见明显异常但怀疑骨折8例.MRI检查显示,6例X线提示骨折患儿中,4例存在骺软骨损伤;5例"八"字征阳性中MRI均提示有不同程度的骨骺骨折、桡骨小头骨折;4例软组织肿胀均存在骨骺骨折及骨髓水肿,且水肿在距离骺板1 cm范围内.8例X线检查阴性但怀疑骨折的患儿中,6例MRI显示骺板、骨骺损伤,2例仅发现存在骨髓水肿且水肿范围距离骺板1 cm以外. 结论 MRI可以更加准确的诊断儿童肘关节骨骺损伤,减少漏诊.     

股骨头骨骺滑脱的X线诊断

目的:探讨股骨头骨骺滑脱的X线表现,着重分析早期和轻度滑脱的X线征象及原因。方法:21例均照骨盆前后位平片,18例加照蛙式髋关节侧位片,15例作了CT、MRI检查。结果:中度以上滑脱者5例,早期轻度滑脱者16例。其X线表现:骺线增宽或明显增宽者10例。后倾角增大,部分骺线内窄外宽者7例。股骨颈弯曲伴内侧皮质增厚者4例。并发缺血坏死者4例。结论:骨盆前后位特别是蛙式位髋关节侧位片联合应用CT、MRI对早期轻度的股骨头滑脱有一定的诊断价值。     

Congenital hypothyroidism--correlation between radiographic appearances of the knee epiphyses and biochemical data

Plain knee radiographs of 20 neonates with congenital hypothyroidism, were reviewed. The size and appearances of the epiphyses were compared with the biochemical data at the time of referral. Fifteen infants had unequivocal evidence of delayed bone maturation based on absence of the distal femoral epiphysis or small epiphyseal size. Seven cases had fragmentation of at least one epiphysis. A positive correlation was found, at diagnosis, between the thyroxine and triiodothyronine levels and the size of the knee epiphyses. All 14 infants with thyroxine levels of less than 70 nmol/l had small epiphyses with a combined mean diameter of the proximal tibial plus distal femoral epiphyses of 7 mm or less. Conversely, of the 6 infants with thyroxine levels of 70 nmol/l or above, 5 had combined epiphyseal diameters of greater than 10 mm. We suggest that in infants with no clinical symptoms and only moderately raised raised screening thyroid stimulating hormone, a knee radiograph showing the described radiological changes should prompt institution of thyroxine treatment before awaiting biochemical confirmation of the diagnosis.     

青少年膝关节骨骺损伤的MRI表现

目的 探讨青少年膝关节骨骺损伤的MRI表现及其诊断价值.方法 回顾性分析18例青少年膝关节骨骺损伤病人的MRI表现.结果 股骨远端骨骺损伤7例,按Salter-Harris分类法分类,SalterⅡ型3例,SalterⅢ型4例;胫骨近端骨骺损伤10例,SalterⅡ型3例,SalterⅢ型5例,SalterⅣ型2例;髌...     

Apparent or true neonatal hip dislocation? Radiologic differential diagnosis

A case of neonatal separation of the proximal femoral epiphysis secondary to obstetric trauma is presented. The radiologic differential diagnosis, as in other cases of neonatal dislocation of the hip, included congenital and septic dislocation of the hip and epiphyseal separation - so-called apparent dislocation. When clinical and laboratory signs are minimal or equivocal, x-ray films and, in difficult cases, contrast arthrograms are needed for an accurate diagnosis of neonatal dislocation of the hip.     

骨骺分离技术在儿童骨肉瘤保肢术中的应用

目的:分析骨骺分离技术在儿童保肢技术中应用的效果。方法:通过回顾性调查2007年3月至2010年3月我科采用该方法治疗的儿童骨肉瘤3例患者,并与同期采用切除骨骺、同种异体半关节置换的病例4例进行对比研究,对病人术中情况及术后骨愈合、患肢功能、并发症等情况进行观察。结果:3例患者在手术时间、出血量及术后关节功能、肢体生长长度差异等指标较对照组均有差异。采用该手术方法的3例患者术后均达到良好肢体活动功能,且未发生复发、感染、骨折及不愈合等并发症。结论:采用骨骺分离技术保留骨骺,可以达到肿瘤广泛切除,并保留关节功能和患肢正常生长等优点,具有良好的临床应用前景。     

19例儿童胫骨近端骺板骨折的治疗

目的：探讨儿童胫骨近端骺板骨折的治疗、并发症及预后。方法选择2002年1月至2012年6月儿童胫骨近端骺板骨折19例,均为单侧闭合性骨折。采用闭合复位长腿管型石膏固定10例,闭合或切开复位内固定9例。结果19例患儿全部获得随访,随访时间2～4．8年,平均2．8年。骨折愈合时间8．5～20周,平均11．8周。按照Lysholm评分系统对膝关节功能进行疗效评定,优：12例,良：4例,可：2例,差：1例。其中1例出现膝外翻畸形,1例出现创伤性关节炎导致膝关节疼痛,1例出现骺板部分早闭。结论对于闭合复位失败、骨折移位明显的Ⅰ型、Ⅱ型骨折,及关节面下陷超过2 mm或者劈裂骨折移位超过5 mm的Ⅲ型或Ⅳ型骨折,应行切开复位内固定术,采用克氏针或空心加压螺钉固定治疗,可以达到满意的疗效。     

骨骺部位及其闭合时间与骨折部位及其发病率对应关系的初步研究

［摘要］〖HTSS〗人体骨骺出现及闭合时间因骨骼部位不同而存在差异。在临床中发现,机体受到间接暴力造成骨折时,骨骺接合部的骨折发生率较高,骨骺闭合较晚的部位较临近部位更易发生骨折,且骨折线走形与骺板融合部走形存在一定相关性。本文对全身重要骨骺部位及其闭合时间与骨折部位及其发生率的对应关系进行了初步研究。     

Psoriasis and gout

Ten cases of gouty arthritis are described in association with psoriasis. Eight were receiving intensive inpatient treatment for their skin condition. Diagnosis was based on clinical grounds or, in 3 cases, by compensated polarizing microscopy (CPM) of synovial fluid. All patients were male and 5 of them had conditions other than psoriasis known to predispose to hyperuricaemia. The patients appeared to fit into three groups: five had typical lower limb gout occurring in conjunction with long-standing extensive psoriasis; 3 patients had preceding features of inflammatory synovitis, one of whom subsequently developed typical distal interphalangeal involvement of peripheral psoriatic arthritis; two patients appeared to have coincident gout and psoriasis.     

Epiphyseal injuries in the growing athlete.

The epiphyses and epiphyseal plates are vital structures in the bone development of the growing athlete. The epiphyseal plate is two to five times weaker than the surrounding fibrous tissue in children and adolescents; consequently a force causing a ligamentous tear in adults is likely to cause an epiphyseal plate injury in growing children. Two types of epiphyseal injury that are common in the growing athlete are (a) separation across the epiphyseal plate, which is usually produced by a direct blow to the joint area or by a strong muscular contraction, and (b) traumatic epiphysitis, the more common of the two, which is usually caused by strong, repetitive contraction of a muscle attached to a traction epiphysis. Each epiphyseal site has specific anatomic features and the forces causing injury differ slightly at each site. An improperly treated separation of an intra-articular pressure epiphysis can have a disastrous effect on the proper functioning of the normally well-fitted articulation of bone ends in the joint. Consequently, proper diagnosis and treatment are essential. Traumatic epiphysitis can result in chronic inflammation or fragmentation, or both, if the condition is not arrested. Therefore the athlete must discontinue the activities that are causing the trauma until the inflammation is completely arrested. Absolute rest may even be required.     

非肿瘤性枕叶癫痫的临床特点与手术治疗

目的：总结分析顽固性额叶癫痫手术治疗效果和经验。方法：回顾性分析2001年7月到2002年11月在我科接受手术治疗的20例枕叶癫痫病例，统计患者的发病、检查及手术治疗情况，并介绍相关手术体会。结果：18例(90％)以强直-痉挛性发作为主，65％有单侧为主的症状，17例(85％)有MRI影像异常，幻觉先兆8例(40％)，术前应用128导长程视频脑电图检查定位局限于单侧枕叶14例(70％)，颞枕叶5例(25％)，双枕叶以一侧为主1例，与术中的皮层脑电图定位吻合率达到100％；手术包括病灶切除13例(65％)，海马切除4例(20％)，胼胝体切开1例，均行多处软膜下横切术，无远期手术并发症；术后疗效满意16例(80％)，显著改善3例(15％)、良好1例(5％)。结论：顽固性非肿瘤枕叶癫痫患者的特点多有结构异常，以单侧为主的强直-痉挛性癫痫多见，幻视先兆常见，手术效果好。