超声及MELCHIORRE评分在儿童血友病性膝关节病诊断中的价值

目的探讨超声及MELCHIORRE评分在儿童血友病性膝关节病诊断中的价值。方法对35例临床确诊的血友病患儿的35个靶关节进行超声检查,观察受检关节的声像图特点,行MELCHIORRE评分,并同期行MRI增强检查,根据关节病变程度将患儿分为两组,并比较两种检查方法对两组患儿各阳性病变检出情况及评分的一致性。结果早期软组织病变16例,另19例合并骨、软骨病变,随着出血次数增加,超声评分明显增加(F=0.824,P<0.01)。超声与MRI对16例早期软组织病变(关节积液、滑膜增厚、含铁血黄素沉积)检出的一致性好至优秀(K=0.636~0.818,P<0.01),两种方法对关节病变评分的一致性好(K=0.747,P<0.01);对19例晚期骨软骨病变各阳性病变(关节积液、滑膜增厚、含铁血黄素沉积、软骨破坏)检出的一致性中等至好(K=0.441~0.642,P<0.05);而对(骨侵蚀、关节下囊肿)检出的一致性差(K=0.224~0.313,P<0.05),两种方法对关节病变评分的一致性差(K=0.272,P<0.01)。结论超声与MRI在诊断儿童血友病性膝关节早期软组织病变方面有较好的一致性,超声能够动态监测疾病的活动性,应作为儿童血友病关节随访的首选检查,MELCHIORRE评分适用于早期软组织病变的评估,可作为临床治疗、随访提供依据。

Discuss the Diagnostic Value of High-frequency Ultrasonography and MELCHIORRE Score for Haemophilic Arthropathy in the Knee Joints of Children

Objective Discuss the diagnostic value of high-frequency ultrasonography and MELCHIORRE score for pediatric haemophilic arthropathy in the knee joints.Methods We collected 35 cases which were diagnosed with haemophilic gonarthrosis and performed ultrasonography as well as MRI enhancement scans in their joints.We investigated ultrasonographic characteristics of lesions and made MELCHIORRE score.We divided the patients into two groups according the severity of lesion and compared the diagnostic consistency and estimated consistency of the two methods between the two groups.Results 16 of 35 cases have incipient soft tissue damage,the other 19 cases have soft tissue damage accompanied with osteochondral destruction.With the number of knee bleed episodes increasing,the score of ultrasonography increasing significantly(F=0.824,P<0.01).The diagnostic consistency of ultrasonography and magnetic resonance imaging toward 16 cases with incipient soft tissue damage(hydrops articuli,Synovial hypertrophy and hemosiderin)was from good to excellent,and the estimated consistency of the two methods toward joint lesions was good(K=0.747,P<0.01).The diagnostic consistency of the two methods toward 19 cases with osteochondral destruction(hydrops articuli,Synovial hypertrophy and hemosiderin and cartilage loss)was from general to good(K=0.441~0.642,P<0.05),however,the diagnostic consistency of the two methods toward osseous erosion and subchondral cysts was poor(K=0.224~0.313,P<0.05)and the estimated consistency of the two methods toward joint lesions among these cases was weak(K=0.272,P<0.01).Conclusions High frequency ultrasonography and MRI have good diagnostic consistency in incipient soft tissue damage of haemophilic gonarthrosis.Ultrasonography can monitor disease activity dynamically,should be used as the preferred examination of children′s hemophilia joints follow-up.MELCHIORRE score is suitable for theassessment of incipient soft tissue damage and provide important basis for treatment,and follow-up.