Department of Neuropediatrics, Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
Department of Pediatric Surgery, Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
Medicine (Baltimore). 2022 May 13;101(19):e29258. doi: 10.1097/MD.0000000000029258.
Supracondylar humerus fractures (SHF) are the second most common fracture in children and the most common fracture in children under seven years. Subtle neurovascular lesions in displaced SHF may be underdiagnosed clinically, but their sequelae can mean life-long symptoms. Here we show that color-coded duplex ultrasound (DUS) could help to identify these patients.
We reviewed records of 229 children who had recovered from SHF. Ninety patients were available for detailed questionnaires, in-depth neurovascular examinations, and DUS.
In 90 examined patients, only two had been known to have suffered from vascular complications before our study. Only one still complained spontaneously about perfusion-induced symptoms. Qualitative changes in blood flow in duplex-sonography were detectable in both. Another two patients showed similar changes in blood flow at the fracture site. Both reported load-induced pain and paresthesia on detailed inquisition when no vascular impairments had been known before. Thus, duplex-sonography identified two patients with vascular affections that had not been noticed before in routine clinical examinations.
DUS can be a sensitive tool in diagnosing vascular impairments in patients with SHF. It could reduce diagnostic insecurity, especially in anesthetized or otherwise hard to examine children, and thus help avoid the therapeutic delay that otherwise might foster life-long sequelae for the patients. More studies are needed to establish age-adjusted reference values for duplex-sonography of children's arms. Level of Evidence: Level III, Study of nonconsecutive patients (without consistently applied reference).
肱骨髁上骨折（SHF）是儿童中第二常见的骨折，也是 7 岁以下儿童中最常见的骨折。移位的 SHF 中细微的神经血管损伤在临床上可能被漏诊，但它们的后遗症可能意味着终生症状。在这里，我们表明彩色编码双功能超声（DUS）可以帮助识别这些患者。
我们回顾了 229 例儿童 SHF 康复患者的记录。90 名患者可接受详细的问卷调查、深入的神经血管检查和 DUS。
在 90 名接受检查的患者中，只有两名患者在我们的研究之前就已知患有血管并发症。只有一名患者仍自发地抱怨灌注引起的症状。在 DUS 中可以检测到两者的血流定性变化。另外两名患者在骨折部位的血流也显示出类似的变化。这两名患者在详细询问时都报告了负重引起的疼痛和感觉异常，而之前并没有发现血管损伤。因此，DUS 可以识别出在常规临床检查中未被注意到的两名患有血管疾病的患者。
DUS 可以成为诊断 SHF 患者血管损伤的敏感工具。它可以减少诊断的不确定性，特别是在麻醉或其他难以检查的儿童中，从而有助于避免治疗延迟，否则可能会对患者造成终生的后遗症。需要更多的研究来建立儿童手臂 DUS 的年龄调整参考值。证据水平：III 级，非连续患者的研究（无一致应用的参考值）。
