Chauvin Nancy A, Ho-Fung Victor, Jaramillo Diego, Edgar J Christopher, Weiss Pamela F
Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA,
Pediatr Radiol. 2015 Aug;45(9):1344-54. doi: 10.1007/s00247-015-3313-0. Epub 2015 Mar 6.
Tendon insertion pathologies such as enthesitis and apophysitis in children can result from trauma, overuse syndrome and arthritis. Knowledge of the US appearance of normal joints by age might aid diagnosis of pathologies.
We describe the age-related sonographic features of the elbows, knees and feet in healthy children, providing a reference for the normal appearance of tendon insertions, apophyseal cartilage and bursae.
This is a prospective cross-sectional study of 30 healthy children. Children were grouped according to age: group 1 (4-9 years, n = 11), group 2 (10-13 years, n = 9) and group 3 (14-18 years, n = 10). Children completed pain and function questionnaires and underwent a standardized joint examination by a pediatric rheumatologist. The common extensor, common flexor, quadriceps, patellar and Achilles tendons and plantar fascia insertions were evaluated with gray-scale and power Doppler ultrasound. The anterior elbow, suprapatellar and retrocalcaneal bursae were evaluated for fluid. We measured the apophyseal cartilage thickness at the enthesis. Correlation analyses examined associations between age and tendon thickness. We used ANOVA, with location as a repeated measure, to test for gender differences in cartilage thickness.
Children had a median age of 12.4 years and 55% were boys. All 360 entheses appeared normal on gray-scale imaging. There was a strong linear relationship between tendon thickness and age. Tendon vascularity was only present in young children (group 1), in 7/22 (32%) quadriceps tendons. Peri-tendinous power Doppler signal was seen at seven sites: two patellar, four quadriceps and one common flexor tendon, and all these children were in group 2. Suprapatellar bursal fluid <3 mm was detected in 9/60 (15%) knees. Of the children in group 1, boys had thicker apophyseal cartilage than girls at the medial epicondyle, patellar poles and os calcis (P < 0.05).
Tendon vascularity may be a normal finding in young children, and mild peri-tendinous vascularity is not uncommon in children 10-13 years of age. Tendon thickness has a linear relationship with age; however cartilage thickness varies across sites and also differs as a function of gender.
儿童的肌腱附着点病变，如附着点炎和骨骺炎，可由创伤、过度使用综合征和关节炎引起。了解不同年龄段正常关节的超声表现可能有助于病变的诊断。
我们描述健康儿童肘部、膝部和足部与年龄相关的超声特征，为肌腱附着点、骨骺软骨和滑囊的正常表现提供参考。
这是一项对30名健康儿童进行的前瞻性横断面研究。儿童按年龄分组：第1组（4 - 9岁，n = 11），第2组（10 - 13岁，n = 9）和第3组（14 - 18岁，n = 10）。儿童完成疼痛和功能问卷，并由儿科风湿病学家进行标准化的关节检查。使用灰阶和能量多普勒超声评估常见伸肌腱、常见屈肌腱、股四头肌、髌腱和跟腱以及足底筋膜附着点。评估肘前、髌上和跟腱后滑囊内有无积液。我们测量了附着点处骨骺软骨的厚度。相关性分析检查年龄与肌腱厚度之间的关联。我们使用方差分析，将部位作为重复测量因素，以检验软骨厚度的性别差异。
儿童的中位年龄为12.4岁，55%为男孩。在灰阶成像上，所有360个附着点均显示正常。肌腱厚度与年龄之间存在很强的线性关系。肌腱血管仅在幼儿（第1组）中出现，在22个股四头肌肌腱中有7条（32%）出现。在7个部位可见肌腱周围能量多普勒信号：2条髌腱、4条股四头肌肌腱和1条常见屈肌腱，所有这些儿童均在第2组。在60个膝关节中有9个（15%）检测到髌上滑囊积液<3 mm。在第1组儿童中，男孩在内侧髁、髌极和跟骨处的骨骺软骨比女孩厚（P < 0.05）。
肌腱血管在幼儿中可能是正常表现，轻度的肌腱周围血管在10 - 13岁儿童中并不少见。肌腱厚度与年龄呈线性关系；然而，软骨厚度因部位而异，并且也因性别而有所不同。
