Bajelidze Gela, Belthur Mohan V, Littleton Aaron G, Dabney Kirk W, Miller Freeman
Department of Orthopaedics, Alfred I duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE 19899, USA.
J Pediatr Orthop. 2008 Jan-Feb;28(1):112-7. doi: 10.1097/BPO.0b013e3181558bc1.
Pain in noncommunicative children can be difficult to localize and diagnose. The purpose of this study is to report our experience using a 3-phase whole-body technetium bone scan as a screening tool in identifying the source of persistent pain in children with profound disabilities who cannot communicate.
We reviewed the medical and imaging records of 45 patients who met the inclusion criteria of the study, which included a diagnosis of spastic quadriplegic cerebral palsy with severe motor and cognitive impairment, persistent pain of more than 1 week in duration with no recognizable source, and a 3-phase whole-body bone scan as part of the pain workup.
The study group included 26 females and 19 males with an average age at presentation of 13.5 years (range, 3-20 years). A positive bone scan was seen in 24 patients (53%). The diagnosis and the source of pain were identified in all 24 patients with a positive bone scan, with the bone scan being instrumental in establishing a diagnosis or localization in 22 patients. An orthopaedic diagnosis was not established in the 21 other patients with a negative bone scan. Based on the bone scan results, additional imaging was obtained at the anatomical location indicated. The bone scan was used to establish a diagnosis of fracture in 10 of 24 patients. Other diagnoses included 3 patients with painful internal hardware, 2 with sinusitis, 2 with infections, and 1 with an obstructed kidney.
Whole-body bone scan is a viable imaging option to identify the source of persistent pain in children who are noncommunicative. The bone scan can assist in localizing the source of pain and direct the location for further imaging as needed.
无法交流的儿童的疼痛可能难以定位和诊断。本研究的目的是报告我们使用三相全身骨扫描作为筛查工具来确定无法交流的重度残疾儿童持续性疼痛来源的经验。
我们回顾了45例符合研究纳入标准患者的医疗和影像记录，这些标准包括痉挛性四肢瘫脑瘫伴严重运动和认知障碍的诊断、持续时间超过1周且无明显来源的持续性疼痛，以及作为疼痛检查一部分的三相全身骨扫描。
研究组包括26名女性和19名男性，就诊时的平均年龄为13.5岁（范围3 - 20岁）。24例患者（53%）骨扫描呈阳性。在所有24例骨扫描阳性的患者中均确定了疼痛的诊断和来源，骨扫描对22例患者的诊断或定位起到了重要作用。另外21例骨扫描阴性的患者未确诊为骨科疾病。根据骨扫描结果，在指示的解剖部位进行了额外的影像学检查。骨扫描用于确诊24例患者中的10例骨折。其他诊断包括3例有疼痛的内置硬件、2例鼻窦炎、2例感染和1例肾梗阻。
全身骨扫描是确定无法交流儿童持续性疼痛来源的可行影像学选择。骨扫描有助于定位疼痛来源，并根据需要指导进一步影像学检查的部位。
