Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
Department of Radiology, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
Skeletal Radiol. 2024 Nov;53(11):2437-2447. doi: 10.1007/s00256-024-04670-y. Epub 2024 Apr 1.
To identify MRI findings that can indicate chronic physeal stress injury and differentiate it from acute Salter-Harris (SH) fracture of the pediatric knee or wrist.
IRB-approved retrospective study of consecutively selected knee and wrist MRIs from 32 athletes with chronic physeal stress injury and 30 children with acute SH fracture. MRI characteristics (physeal patency, physeal thickening, physeal signal intensity (SI), continuity of the zone of provisional calcification (ZPC), integrity of the periosteum and/or perichondrium, pattern of periphyseal and soft tissue edema signal, and joint effusion) were compared.
Forty-eight chronic physeal stress injuries (mean age 13.1 years [8.2-17.5 years]) and 35 SH fractures (mean age 13.3 years [5.1-16.0 years]) were included. Any physeal thickening was more common with chronic stress injury (98% vs 77%, p = 0.003). Abnormal physeal SI was more common with SH fractures (91% vs 67%, p = 0.008). ZPC discontinuity strongly suggested chronic stress injury (79% vs 49%, p < 0.004). Periosteal and/or perichondrial elevation or rupture and soft tissue edema characterized most of the acute SH fractures (p < 0.001) and were seen only in 1 chronic stress injury (< 2%). While periphyseal edema was not significantly different in the two groups (p = 0.890), a joint effusion was associated with acute SH fracture (p < 0.001).
Chronic physeal stress injury of the pediatric knee and wrist shows higher incidence of ZPC discontinuity and focal physeal thickening compared to SH fracture, reflecting disruption in normal endochondral ossification. However, these findings can overlap in the 2 groups. Periosteal and/or perichondrial injury, soft tissue edema signal, and joint effusion strongly suggest SH fracture and are rarely present with chronic stress injury.
确定能提示慢性骺板应力损伤并将其与儿童膝关节或腕关节急性 Salter-Harris（SH）骨折相鉴别的 MRI 表现。
对 32 例慢性骺板应力损伤运动员和 30 例急性 SH 骨折患儿连续选择的膝关节和腕关节 MRI 进行 IRB 批准的回顾性研究。比较 MRI 特征（骺板是否通畅、骺板增厚、骺板信号强度（SI）、临时钙化带（ZPC）的连续性、骨膜和/或软骨膜的完整性、骨旁和软组织水肿信号的模式以及关节积液）。
纳入 48 例慢性骺板应力损伤（平均年龄 13.1 岁[8.2-17.5 岁]）和 35 例 SH 骨折（平均年龄 13.3 岁[5.1-16.0 岁]）。慢性应力损伤更常见任何骺板增厚（98%比 77%，p=0.003）。骺板异常 SI 更常见于 SH 骨折（91%比 67%，p=0.008）。ZPC 不连续强烈提示慢性应力损伤（79%比 49%，p<0.004）。骨膜和/或软骨膜抬高或破裂以及软组织水肿是大多数急性 SH 骨折的特征（p<0.001），仅在 1 例慢性应力损伤中发现（<2%）。虽然两组的骨旁水肿无显著差异（p=0.890），但关节积液与急性 SH 骨折相关（p<0.001）。
与 SH 骨折相比，儿童膝关节和腕关节慢性骺板应力损伤的 ZPC 不连续性和局灶性骺板增厚发生率更高，反映了正常骺软骨内骨化的中断。然而，这两种情况在两组中可能会重叠。骨膜和/或软骨膜损伤、软组织水肿信号和关节积液强烈提示 SH 骨折，而在慢性应力损伤中很少出现。
