新兵集训期膝关节未完全闭合生长板损伤的MRI表现与特点

 目的 探讨新兵集训期膝关节未闭合生长板损伤的MRI表现与特点。方法 采用生长板闭合程度Tanner分级及损伤S-H(Salter-Harris)Ⅰ～Ⅶ型分类, 回顾分析36例新兵集训期膝关节未闭合生长板损伤MRI影像资料。结果 (1)36例膝关节生长板损伤计39块, 股骨下段10块, 胫骨上段29块, 其中股骨下段及胫骨上段同时损伤3例计6块。(2)39块生长板闭合程度Tanner分级:1级19块, 2级17块, 3级3块。(3)生长板损伤S-H分型:Ⅱ型2块, Ⅲ型5块, Ⅳ型4块, Ⅴ型22块, Ⅵ型6块, 无Ⅰ型及Ⅶ型。(4)损伤急性期MR表现出血、水肿信号, 随时间变化可出现长T₂、等T₂及短T₂多信号, 后期水肿减轻或消退、出血吸收、组织坏死囊变及纤维化等病理组织信号。(5)影像随访:生长板同步闭合27块;非同步闭合12块(提前4块、延时8块)均为Ⅴ型损伤;形态良好21块, 形态改变18块(局部肥大或类似骨桥形成9块、不均匀变薄9块), 其中Ⅴ型损伤11块。(6)36例临床预后良好29例, 轻度关节畸形7例(膝轻度内翻2例、膝轻度外翻4例、患肢轻度缩短1例)均为Ⅴ型损伤病例。结论 本组资料显示新兵集训期膝关节未闭合生长板损伤多发生于一侧膝关节和集训早期, 生长板闭合程度低和年龄小越容易损伤。临床及时处理可获良好预后。

MRI of injury of incomplete closed growth plate of knee in the recruits during military training

Objective To study MRI performance and characteristics of the incomplete closed growth plate injury of knee in the recruits during intensive training. Methods Retrospective analysis was made of MRI of growth plate injury of 36 recruits knees in military training. Tanner’s grading of the growth plate closure degree was used, and adopting S-H (Salter-Harris, S-H) Ⅰ～Ⅶ classification of the growth plate damaged was adopted. Results (1)There were 39 pieces of growth plate injury among 36 cases(knee):10 pieces in the distal femora and 29 pieces in the proximal tibia, including 6 pieces of 3 cases of the femur and tibia injuries at the same time on them. (2) Tanner’s staging of the closure degree displayed growth plate in 36 recrruits by imaging: 19 of 39 were degree 1, 17 were degree 2, 3 were degree 3. (3) S-H classification: 2 of 39 were typeⅡ, 5 were type Ⅲ, 4 were type Ⅳ, 22 were type Ⅴ and 6 were typeⅥ. There were no typeⅠand type Ⅶ.(4) MRI signal of hemorrhage and edema were displayed in the acute phase of growth plate injury.MRI signals changed with time, could manifest signals of more than short T₂, such as T₂ and long T₂. However, edema relieved or subsided in the later, stage and MRI signal displayed a variety of changes with the pathological events such as bleeding absorbed, necrosis, cystic degeneration and fiberosis of damaged tissue of growth plate. (5) Followed up by imaging: 27 pieces were closed over the same period of the unaffected side in the growth plate injury of 39 pieces. 12 pieces of growth plate were asynchronously closed (early 4, delayed 8) , which were the damage of typeⅤ. In shape, 21 pieces were of normal form. The rest of the 18 changed in the form (local bone hypertrophy or similar bone bridge form 9, non-uniform thickness and thinning 9). 11 of 18 were the damage of the type Ⅴ.(6)Good clinical prognosis in 29 cases of 36 cases. 7 cases with joint deformity (knee varus 2, knee valgus 4, limb slightly shorter 1), they were of typeⅤ. Conclusions The incompletely closed growth plate of knee may be damaged during the recruit military training. Most occurred at the beginning of the training and only one side of knee. Recruits are relatively young, their growth plate closure degree is low and susceptible to injury mostly of type Ⅴ. Timely clinical treatment promises good prognosis.