小儿单侧髋关节暂时性滑膜炎的B超诊断及分型

目的 :探讨B超诊断小儿单侧髋关节暂时性滑膜炎的诊断建议值和分型。材料和方法 :对 10 6例单侧髋关节暂时性滑膜炎病例 ,采用髋关节前侧切面进行双髋B超对比检查 ,并随机抽取与病例组年龄范围相同的 87例健康儿童进行双髋B超检查 ,作为对照组。结果 :所有的髋关节暂时性滑膜炎病例患髋股骨颈颈前间隙均较健侧增宽 ,平均增宽值为 2 4～ 4 6mm ,其中 ,76例患侧关节腔尚存在积液。结论 :双髋B超对比检查 ,当双侧股骨颈颈前间隙的差值 >1mm时 ,可诊断为该病 ,并可分为“关节腔积液型”和“关节囊肿胀型”     

小儿髋关节暂时性滑膜炎的彩色多普勒超声表现

目的:探讨彩色多普勒超声在小儿髋关节暂时性滑膜炎的临床价值。方法:选取髋关节暂时性滑膜炎患儿38例,应用彩色多普勒超声对患儿治疗前后髋关节滑膜内细小血管的血供情况和频谱多普勒进行血流检测评价。结果:患儿治疗前,肿胀组与积液组滑膜增厚型的病例患侧髋关节滑膜内血流信号较健侧明显丰富;肿胀组血流速度升高,积液组血流速度减低。治疗后1周,肿胀组及积液组患髋滑膜内的血流信号较治疗前有所下降;肿胀组血流速度减低,积液组血流速度升高。治疗后2周,两组患髋滑膜内血流信号基本同健侧。结论:多普勒超声能监测小儿髋关节暂时性滑膜炎髋关节滑膜内的血供改变,对疾病的诊断和疗效观察有重要的应用价值。     

儿童髋关节一过性滑膜炎的MRI表现

目的探讨儿童一过性髋关节滑膜炎的磁共振诊断价值。方法分析23例儿童一过性髋关节滑膜炎的磁共振影像资料,所有患儿行横断位T2WI+FS、T1WI,冠状位用T2WI+FS、T1WI,采用常规自旋及快速自旋回波序列。结果23例患儿共28侧髋关节发病,18例为单侧发病,5例为双侧,所有病变髋关节不同程度关节积液,T2WI上表现为关节腔内片状、带状高信号影,T1WI上呈低信号,6侧关节滑膜增厚,4侧关节周围软组织肿胀,所有患侧股骨头骨骺、干骺端及髋臼骨质正常。6例治疗2~5周后复查,基本恢复正常。结论磁共振对儿童一过性髋关节滑膜炎的诊断安全、可靠,在诊断与鉴别诊断上具有很高的价值。     

中老年脑功能障碍股骨颈骨折的髋关节置换

目的探讨中老年伴有脑功能障碍的股骨颈骨折患者行人工髋关节置换治疗的疗效。方法回顾分析本科于2000年1月～2008年12月收治的伴有脑功能障碍的股骨颈骨折行人工髋关节置换手术治疗的43例临床资料。结果本组有38例在术后3～21天扶拐下地活动,平均8天,有5例在住院期间未能恢复下地活动;术后1例死亡,3例髋关节假体在术后4周内脱位,2例出现假体周围骨折。本组病例有20例得到随访,随访时间为6个月～6年,平均2年7个月,术后2～6个月患肢功能逐渐恢复至近似于术前的功能状态。结论伴有脑功能障碍的股骨颈骨折患者行人工髋关节置换是可行的,是恢复髋关节功能、减少卧床并发症的较好治疗方法;但其并发症、不满意度、死亡发生率均比一般人群要高,髋关节的功能会随着患者脑功能障碍的进展而逐渐减退,临床治疗上应作好充分评诂。     

老年股骨颈骨折松质骨螺丝钉内固定的治疗

目的：通过采用松质骨螺丝钉内固定治疗38例老年股骨颈骨折的观察，探讨松质骨螺丝钉对老年股骨颈骨折治疗的疗效。方法：所有病例均于骨折的早期经大粗隆外侧切口行松质骨螺丝钉内固定术，术后穿木板鞋，3天后行患侧膝关节的持续被动练习和主动运动，3周后行髋关节功能锻炼。结果：所有病例骨折，愈合时间为8—12周，平均10周，4—6周开始负重。关节功能恢复良，关节优良率95％。结论：松质骨螺丝钉应用于老年股骨颈骨折治疗疗效可靠，费用低，是老年股骨颈骨折治疗的理想方案。     

三相骨显像对髋关节一过性滑膜炎动物实验的研究

在２１只幼狗的髋关节内注入去甲肾上腺素（ＮＡ），以诱导一过性滑膜炎．用核素三相骨显像和病理组织学检查观察注药侧股骨头血供和病理变化．结果表明髋关节内注入ＮＡ可诱发注药侧髋关节一过性滑膜炎（ＴＳＨ）和股骨头血供降低，但于４周后恢复正常．未见股骨头坏死迹象．故动态核素三相骨显像的定量分析对ＴＳＨ具有早期诊断和判断病程阶段等实用价值．     

股骨干骨折漏诊同侧髋关节损伤6例分析

股骨干骨折并同侧髋关节损伤,临床少见.我院近年来收治此类患者12例,漏诊6例.现就6例漏诊病例分析报道如下. 临床资料 本组6例,男4例,女2例.年龄16～49岁,均为车祸损伤.其中股骨干骨折并同侧髋关节脱位2例,并同侧髋臼粉碎性骨折及髋关节脱位2例,并同侧股骨颈骨折2例.1例在牵引治疗1周后床边照片复查时偶然发现同侧髋关节脱位(图1),1例在入院3天后诉同髋关节痛照片检查发现髋臼骨折(图2).     

经导管置入Amplatzer封堵器治疗儿童膜部室间隔缺损及疗效评价

目的　经导管置入Amplatzer膜部室间隔缺损封堵器治疗儿童膜部室间隔缺损(perimembraneventricularseptaldefect,PMVSD)并对其疗效进行评价。方法　 5例PMVSD患儿术前均经胸超声心动图确诊 ,术中经左心室造影测量缺损直径 ;所有病例均在透视和经胸超声心动图监视下经导管置入Amplatzer封堵器堵闭PMVSD ;术后 2 4h、1、3、6个月分别行经胸超声、心电图及X线检查观察临床疗效。结果　术中经左心室造影测量缺损直径为 2 .5～ 8.3mm ,平均 (5 .0± 2 .4 )mm ;选用 4～ 10mm ,平均 (7.4± 3.2 )mmAmplatzer封堵器堵闭PMVSD ,全组技术成功率 10 0 % ,术中未发生严重并发症 ;全部患儿术后即刻造影检查无残余分流 ;术后 2 4h、1、3及 6个月经胸超声心动图检查封堵器位置良好 ,无残余分流 ,心电图检查未发现心律失常 ,X线检查全部显示肺血减少。结论　经导管置入Amplatzer膜部室间隔缺损封堵器治疗PMVSD是一种成功率高、近期疗效可靠的介入方法 ,其远期疗效需进一步观察     

成人正常股骨头前缘与髋臼前唇连线延长线间距的CT测量

目的 通过CT测量建立成人正常股骨头前缘与髋臼前唇连线延长线间距的正常值标准.方法 对已行盆腹部多层螺旋CT扫描而无髋关节疾患的333例病例,进行薄层骨算法重建、图像MPR后处理,测量股骨头与髋臼前唇连线延长线间距、髋关节前、后间隙并进行统计学分析.结果 成人正常股骨头前缘与髋臼前唇联线延长线间距正常值范围,男性-1.36～4.12mm,平均1.38mm,标准差为1.40mm;女性-2.09～3.67mm,平均0.79mm,标准差1.47mm.成人正常髋关节前间隙正常值范围,男性1.13～4.35mm,平均2.74mm,标准差0.82mm;女性0.94～4.32mm,平均2.63mm,标准差为0.86mm.成人正常髋关节后间隙正常值范围,男性0.7～3.44mm,平均2.07mm,标准差0.70mm;女性0.6～3.26mm,平均1.93mm,标准差0.6gmm.结论 成人正常股骨头前缘与髋臼前唇连线延长线间距正常值范围,男性-1.36～4.12mm,女性-2.09～3.67mm;髋关节前间隙,男性1.13～4.35mm,女性0.94～4.32mm;髋关节后间隙,男性0.7～3.44mm,女性0.6～3.26mm.     

双极人工股骨头置换治疗高龄股骨颈骨折的疗效分析

目的探讨高龄股骨颈骨折应用双极人工股骨头置换的临床疗效。方法对63例高龄股骨颈骨折患者行骨水泥固定的国产双极人工股骨头置换,术后根据Harris评分法和X线资料评定其疗效。结果本组63例均成功完成手术,术中无血管神经损伤。术后无切口感染和关节脱位,无围术期死亡。术后随访10～42(15.3±2.1)个月。术后合并肺部感染6例,泌尿系感染5例,下肢深静脉血栓形成3例,中枢神经系统功能障碍2例,脑梗死1例。X线片检查显示髋关节间隙变窄11例,假体轻度内翻5例,出现假体下沉3例,骨水泥周围<2 mm的透亮带2例。根据Harris评分法评定,优22例,良26例,中12例,差3例,优良率76.19%。结论应用骨水泥固定的双极股骨头置换治疗高龄股骨颈骨折疗效满意。     

Anterior joint capsule of the normal hip and in children with transient synovitis: US study with anatomic and histologic correlation

PURPOSE: To study the anatomic components of the anterior joint capsule of the normal hip and in children with transient synovitis. MATERIALS AND METHODS: Six cadaveric specimens were imaged with ultrasonography (US) with special attention to the anterior joint capsule. Subsequently, two specimens were analyzed histologically. These anatomic findings were correlated with the US findings in 58 healthy children and 105 children with unilateral transient synovitis. RESULTS: The anterior joint capsule comprises an anterior and posterior layer, mainly composed of fibrous tissue, lined by only a minute synovial membrane. Both fibrous layers were identified separately at US in 98 of 116 (84%) hips of healthy subjects and in all hips with transient synovitis. Overall, the anterior layer was thicker than the posterior layer. In transient synovitis compared with normal hips, no significant thickening of both layers was present (P = .24 and .57 for the anterior and posterior layers, respectively). Normal variants include plicae, local thickening of the capsule, and pseudodiverticula. CONCLUSION: Increased thickness of the anterior joint capsule in transient synovitis is caused entirely by effusion. There is no US evidence for additional capsule swelling or synovial hypertrophy.     

Standards for ultrasonographic measurements of the hip joint in Indian adults

Synovitis in the hip joint, in contrast to that in other limb joints, is extremely difficult to evaluate clinically. In the hip joint synovitis manifests as an increase in the distance between the iliofemoral ligament and the femoral neck. The present ultrasonographic study was undertaken in 110 healthy Indian adults to establish standards for the depth of the normal hip joint space in the normal Indian adult population. The shortest distance was 4 mm, the longest was 9 mm. The mean distance was 6.4 (S.D. 1.1) mm. The mean difference between the right and left hips was 0.42 (S.D. 0.49) mm. An age-specific reference curve with 95% confidence limits was constructed. No correlation was found between hip joint space and the subjects' height, weight, age or sex. It is concluded that a distance between the iliofemoral ligament and the femoral neck of more than 9 mm or a difference in measurement between the hips of 1 mm or more suggests an intracapsular effusion or active synovitis. These figures are at variance with the measurements obtained in studies on Western white populations.     

Capsular distance in the hip of the healthy child - normal values with sonography and MR imaging

PURPOSE: To determine the normal values of the anterior and posterior capsular distances of the hip joint in healthy children by means of US, using MR imaging as reference, and to evaluate any possible correlation between age, length, weight and anterior capsular distance (ACD). MATERIAL AND METHODS: In our first study both hips in 14 healthy children (5-18 years old) were examined with US and MR to obtain measurements of the ACD and the posterior capsular distance (PCD). The distance from the anterior or posterior aspect of the femoral neck to the anterior or posterior aspect, respectively, of the outer limit of the capsule was determined. The distances were measured both with the hips in spontaneous external rotation of 10-15 degrees and in internal rotation of 45 degrees. In our second study, both hips in 28 healthy children (3-16 years old) were examined with US to determine the ACD. Age, length and weight were recorded. RESULTS: Study I: There was good correlation between the US and MR measurements in all positions. The ACD measured by US was significantly increased in inward rotation of the hip. Study II: There was no correlation between ACD and age, length or weight. CONCLUSION: The PCD of the hip joint can be accurately measured by US with the hip in internal rotation of 45 degrees. When compared with MR values, the ACD measured by US was dependent on the degree of rotation of the leg and increased significantly in internal rotation. Because the outer limit of the external layer of the joint capsule is sonographically more distinct, we suggest that the capsular distance should be measured from the outer limit of the joint capsule to the anterior or posterior aspect of the femoral neck. The measurement should be made perpendicular to the femoral neck, at the position where the greatest numerical value is obtained.     

Coxitis fugax. The sonographic and radiologic picture in 65 cases

Sonography is a valuable technique for the detection of hip joint effusion in children with transient synovitis. In a retrospective study of 65 patients distension of the anterior recess was found to be increased by 2 mm or more in all patients investigated. A sonographic follow-up examination was carried out in 30 patients. These patients showed complete regression of hip effusion after 4 weeks. The importance of attention to sonographic changes of the adjacent bony outline and femoral head deformity in connection with other hip diseases is emphasized. In 45 patients in this study (62% of the cases) conventional radiography showed one or more indirect signs such as displacement, blurring or even obliteration of the fatty intermuscular planes or an increased joint space. In uncomplicated cases with clear sonographic and clinical findings a pelvic radiogram is unnecessary.     

US assessment of hip joint synovitis in rheumatic diseases. A comparison with MR imaging

PURPOSE: To assess the significance of ultrasonography (US) in detecting hip joint synovitis in patients with rheumatic diseases. MATERIAL AND METHODS: Forty patients with rheumatic disease and suspected hip joint synovitis underwent MRI and US of the hip joint. In addition to the throughout MRI evaluation, the anterior collum-capsule distance (CCD) was determined by both MRI and US. Thirteen healthy volunteers were examined with MRI to establish the criteria for normal findings in MRI when classifying hip joints to those with synovitis and those without. MRI was used as a gold standard. RESULTS: Synovitis was found using MRI in 31 hips of 22 patients (9 patients had bilateral synovitis). The intraclass correlation was 0.61 between MRI and US in measuring CCD. In classifying hip joint synovitis with US, the sensitivity of the method was 87% and specificity 42%, when the CCD criterion for synovitis was determined to be > or = 7 mm. If the cut-off point was raised to 9 mm, the sensitivity decreased to 61% while specificity increased to 94%. A difference in CCD of > or = 1 mm between the hips as an additional criterion for synovitis increased the number of false-positive findings. CONCLUSION: Measurement of CCD with US proved to be a rather inaccurate method to point out synovitis in rheumatic patients when using MRI as a reference. The main reason for this result was the thickened capsule, which US could not differentiate from a thickened synovium.     

Septic arthritis versus transient synovitis at MR imaging: preliminary assessment with signal intensity alterations in bone marrow

PURPOSE: To find any differential magnetic resonance (MR) imaging findings between septic arthritis and transient synovitis in pediatric patients. MATERIALS AND METHODS: The MR imaging findings in nine pediatric patients with septic arthritis and 14 with transient synovitis were retrospectively studied. The diagnoses were made by means of joint aspiration with bacteriologic study, arthrotomy, and clinical evaluation. MR imaging findings were analyzed with emphasis on the grade of joint effusion and alterations in signal intensity in the soft tissue and bone marrow of the affected hip joint. RESULTS: Signal intensity alterations in bone marrow (i.e., low signal intensity on fat-suppressed gadolinium-enhanced T1-weighted spin-echo images and high signal intensity on fat-suppressed T2-weighted fast spin-echo images) were seen in eight of nine patients with septic arthritis. These signal intensity alterations consisted of mild juxtaarticular changes in six patients without osteomyelitis and extensive changes in the femoral head and neck in two patients with coexistent osteomyelitis. Signal intensity alterations in bone marrow were not seen in the 14 patients with transient synovitis. CONCLUSION: Signal intensity alterations in the bone marrow of the affected hip joint are useful in the differentiation of septic arthritis from transient synovitis.     

Doppler sonography of the anterior ascending cervical arteries of the hip: evaluation of healthy and painful hips in children

OBJECTIVE: We evaluated the Doppler sonography of small feeding arteries to the femoral head in children. SUBJECTS AND METHODS: In a prospective study of 224 hips in 112 patients (mean age, 5 years 11 months), the anterior ascending cervical arteries of the hip were identified with color Doppler sonography. Subsequently, we measured the resistive index (RI) with pulsed Doppler sonography. RESULTS: In 61% (137/224) of hips, a Doppler signal could be obtained. In asymptomatic hips (n = 64), the mean RI was 0.58. In symptomatic hips, the definitive diagnoses and mean values of RI included transient synovitis (n = 31) and 0.92, Perthes' disease (n = 9) and 0.67, and miscellaneous (n = 5) and 0.68. In 28 symptomatic hips, no definite diagnosis could be determined and the complaints spontaneously disappeared during follow-up (mean RI, 0.57). We found no statistically significant difference in the RI of symptomatic versus asymptomatic hips, except in patients with transient synovitis (p < 0.001). In 11 hips with transient synovitis that were reexamined after 4-6 weeks, the RI returned to normal (0.57). The RI in symptomatic hips showed a positive correlation with the amount of effusion (r = 0.69, p < 0.001). In symptomatic and asymptomatic hips, we found no correlation with age (p = 0.9 and 0.1, respectively). CONCLUSION: The deep capsular vessels of the hip joint can be evaluated on Doppler sonography in more than 60% of hips. Also, the RI is age independent and correlates with the amount of effusion.     

Pitfalls in ultrasonography of hip joint synovitis in the child

The normal and abnormal anatomy of the hip joint in childhood was evaluated by ultrasonography (US) with reference to examination technique and errors. When compared with computed tomography (CT), it was confirmed that the two sonographic echoes from the hip joint represent the femoral neck and the external surface of the capsule and that the thickness of the echo received from the capsule depends on the frequency of the transducer. Partial volume effects may simulate or increase the sonographic appearance of hip joint effusion. The normal relationship between joint capsule and femoral neck was established.     

Arthrosonography of the irritable hip in childhood: a review of 1 year's experience

A retrospective study of 87 children presenting acutely with an "irritable hip" was undertaken to assess the role of arthrosonography of the hip joint. Arthrosonography detected 52 hip-joint effusions, of which 16 were aspirated and an effusion confirmed in 14 (88%). In 82 cases plain radiography was compared with arthrosonography for the detection of hip-joint effusions. Of 47 children with a positive ultrasound diagnosis, 28 (59%) showed abnormal findings on plain radiographs and, of 35 cases with negative ultrasound findings, 22 (63%) had a negative diagnosis by plain radiography. Patients with more severe clinical signs were more likely to have an ultrasonic diagnosis of an effusion (87%-100%) than those with mild clinical signs (25%). The ultrasonic measurement of the hip-joint capsule to femoral neck distance was 2.2 mm +/- 0.5 mm (mean +/- 1 SD) in normal hips and 6.3 mm +/- 1.5 mm in the joints with effusions. Our study suggests that arthrosonographically the normal capsular space is less than 3 mm and the difference between the two sides less than 2 mm. It is suggested that hip arthrosonography is a more accurate method for detecting hip-joint effusions than plain radiography; it may help select cases for hospital admission and should be performed before aspiration is attempted.