Wessel L M, Scholz S, Rüsch M, Köpke J, Loff S, Duchêne W, Waag K L
Kinderchirurgische Klinik, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim, Germany.
J Pediatr Orthop. 2001 May-Jun;21(3):338-42.
In children, compulsory arthroscopy for hemarthrosis after knee trauma is not justified because ligamentous and meniscal damage is rare. In a prospective study, we analyzed the diagnostic value of radiography, magnetic resonance imaging (MRI), and arthroscopy in 51 patients up to 14 years of age with acute knee trauma. Plain radiography revealed 16 osseous lesions (5 metaphyseal, 3 patellar, 4 physeal fractures, 3 avulsions of the tibial spine, and 1 osseous ligamentous tear). In 29 patients, the cause of hemarthrosis remained unclear. All patients were evaluated by MRI. A diagnosis could be assigned to all 29 patients. MRI demonstrated lesions in 38 patients. In addition, the following lesions were discovered: 8 patellar dislocations, 13 bruises, 1 rupture of the anterior cruciate ligament, 1 osteochondritis dissecans, and 13 joint effusions. In 13 patients, MRI was followed by arthroscopy to confirm the diagnosis. Both, MRI and arthroscopy missed two osteochondral fractures. In addition, three chondral lesions were not picked up by MRI. MRI is a reliable tool for assessing the extent of knee lesions in children.
对于儿童膝关节创伤后出现的关节积血，进行强制性关节镜检查并不合理，因为韧带和半月板损伤很少见。在一项前瞻性研究中，我们分析了X线摄影、磁共振成像（MRI）和关节镜检查对51例14岁及以下急性膝关节创伤患儿的诊断价值。X线平片显示16处骨质病变（5处干骺端病变、3处髌骨病变、4处骨骺骨折、3处胫骨棘撕脱伤和1处骨韧带撕裂）。29例患儿关节积血的病因仍不明确。所有患儿均接受了MRI检查。29例患儿均得以确诊。MRI显示38例患儿存在病变。此外，还发现了以下病变：8例髌骨脱位、13处挫伤、1例前交叉韧带断裂、1例剥脱性骨软骨炎和13处关节积液。13例患儿在MRI检查后接受了关节镜检查以确诊。MRI和关节镜检查均漏诊了2处骨软骨骨折。此外，MRI未发现3处软骨损伤。MRI是评估儿童膝关节损伤程度的可靠工具。
