伍兴 李雄涛 夏敬冬

[摘要] 目的 評估超声在疑似儿童尺桡骨远端骨折中的诊断价值。 方法 收集2018年1～6月华中科技大学同济医学院附属武汉儿童医院骨科急诊收治的131例疑似尺桡骨远端骨折的儿童病例。急诊儿童骨科医师对疑似尺桡骨远端骨折的儿童首先进行超声检查，再完成常规X线检查。两种检查结果均采用盲法。以X线为标准对照，评估超声在儿童尺桡骨远端骨折诊断中的敏感性、特异性、准确性、阳性预测值、阴性预测值和受试者工作特征曲线（ROC）下面积。 结果 超声检查诊断证实55例尺桡骨远端骨折，其中桡骨远端骨折36例，尺桡骨远端双骨折16例，尺骨远端骨折3例。超声检查对尺桡骨远端骨折的诊断敏感性和特异性分别为93.1%和98.6%，准确性为96.2%，阳性预测值98.2%和阴性预测值94.7%。超声诊断阳性率与X线诊断阳性率比较，差异无统计学意义（χ2=0.8，P = 0.371），超声诊断和X线诊断结果一致性较好（Kappa = 0.922，P < 0.001）。超声ROC曲线下面积为0.959（95%CI = 0.917～1.000）。 结论 超声在诊断尺桡骨远端骨折具有高敏感性和特异性。因此，超声是诊断儿童尺桡骨远端骨折的一种可选择的诊断检查方式。

[关键词] 尺桡骨远端骨折;超声;X线;诊断

[中图分类号] R726.8          [文献标识码] A          [文章编号] 1673-7210（2020）07（a）-0144-04

[Abstract] Objective To evaluate the diagnostic value of ultrasound in children with suspected fracture of the distal ulna and radius. Methods A total of 131 children with suspected fracture of the distal ulna and radius were admitted to the emergency Department of Orthopedics， Wuhan Children′s Hospital， Tongji Medical College， Huazhong University of Science & Technology， from January to June 2018. Emergency pediatric orthopedic surgeons performed ultrasound examination first and then completed routine X-ray examination of children with suspected fracture of the distal ulna and radius. The results of both tests were blind. The diagnostic sensitivity， specificity， accuracy， positive predictive value， negative predictive value and area under the receiver operating characteristic curve （ROC） of ultrasound in children′s fracture of the distal ulna and radius were evaluated using X-ray as the standard control. Results Ultrasound examination confirmed 55 cases of fracture of the distal ulna and radius， including 36 cases of fracture of distal radius， 16 cases of double of fracture of the distal ulna and radius and 3 cases of fracture of distal ulnar. The sensitivity and specificity of ultrasound examination for the diagnosis of fracture of the distal ulna and radius were 93.1% and 98.6%， respectively， with an accuracy of 96.2%， a positive predictive value of 98.2% and a negative predictive value of 94.7%. There was no significant difference in the positive rate of ultrasound diagnosis and X-ray diagnosis （χ2=0.8， P = 0.371）， and the consistency of ultrasound diagnosis and X-ray diagnosis was good （Kappa = 0.922， P < 0.001）. The area under ultrasonic ROC was 0.959 （95%CI = 0.917-1.000）. Conclusion Ultrasound has high sensitivity and specificity in diagnosing fracture of the distal ulna and radius. Therefore， ultrasound is an alternative diagnostic test for the diagnosis of fracture of the distal ulna and radius in children.

[Key words] Fracture of the distal radius and ulna; Ultrasound; X-ray; Diagnosis

尺桡骨远端骨折是儿童最常见的骨折，发病率约31.1%[1]。X线作为尺桡骨远端骨折诊断的金标准已经广泛应用。但是X线属于电离辐射，可能危害健康，如增加恶性肿瘤的患病风险[2-4]。

近年来，关于超声诊断儿童骨折的研究日益增多[5-8]。目前超声在诊断儿童尺桡骨远端骨折中的应用主要是干骺端[9-11]。超声已用于骨骺软骨成像[12]。华中科技大学同济医学院附属武汉儿童医院（以下简称“我院”）已经应用超声诊断儿童其他部位的骨骺骨折[13-14]，但相关研究国内外较少。……