CAJ | 학술논문

目的：探讨新兵集训期膝关节未闭合生长板损伤的MRI表现与特点。方法采用生长板闭合程度Tanner分级及损伤 S-H （ Salter-Harris ）Ⅰ～Ⅶ型分类，回顾分析36例新兵集训期膝关节未闭合生长板损伤 MRI 影像资料。结果（1）36例膝关节生长板损伤计39块，股骨下段10块，胫骨上段29块，其中股骨下段及胫骨上段同时损伤3例计6块。（2）39块生长板闭合程度Tanner分级：1级19块，2级17块，3级3块。（3）生长板损伤S-H分型：Ⅱ型2块，Ⅲ型5块，Ⅳ型4块，Ⅴ型22块，Ⅵ型6块，无Ⅰ型及Ⅶ型。（4）损伤急性期MR表现出血、水肿信号，随时间变化可出现长T2、等T2及短T2多信号，后期水肿减轻或消退、出血吸收、组织坏死囊变及纤维化等病理组织信号。（5）影像随访：生长板同步闭合27块；非同步闭合12块（提前4块、延时8块）均为Ⅴ型损伤；形态良好21块，形态改变18块（局部肥大或类似骨桥形成9块、不均匀变薄9块），其中Ⅴ型损伤11块。（6）36例临床预后良好29例，轻度关节畸形7例（膝轻度内翻2例、膝轻度外翻4例、患肢轻度缩短1例）均为Ⅴ型损伤病例。结论本组资料显示新兵集训期膝关节未闭合生长板损伤多发生于一侧膝关节和集训早期，生长板闭合程度低和年龄小越容易损伤。临床及时处理可获良好预后。
목적：탐토신병집훈기슬관절미폐합생장판손상적MRI표현여특점。방법채용생장판폐합정도Tanner분급급손상 S-H （ Salter-Harris ）Ⅰ～Ⅶ형분류，회고분석36례신병집훈기슬관절미폐합생장판손상 MRI 영상자료。결과（1）36례슬관절생장판손상계39괴，고골하단10괴，경골상단29괴，기중고골하단급경골상단동시손상3례계6괴。（2）39괴생장판폐합정도Tanner분급：1급19괴，2급17괴，3급3괴。（3）생장판손상S-H분형：Ⅱ형2괴，Ⅲ형5괴，Ⅳ형4괴，Ⅴ형22괴，Ⅵ형6괴，무Ⅰ형급Ⅶ형。（4）손상급성기MR표현출혈、수종신호，수시간변화가출현장T2、등T2급단T2다신호，후기수종감경혹소퇴、출혈흡수、조직배사낭변급섬유화등병리조직신호。（5）영상수방：생장판동보폐합27괴；비동보폐합12괴（제전4괴、연시8괴）균위Ⅴ형손상；형태량호21괴，형태개변18괴（국부비대혹유사골교형성9괴、불균균변박9괴），기중Ⅴ형손상11괴。（6）36례림상예후량호29례，경도관절기형7례（슬경도내번2례、슬경도외번4례、환지경도축단1례）균위Ⅴ형손상병례。결론본조자료현시신병집훈기슬관절미폐합생장판손상다발생우일측슬관절화집훈조기，생장판폐합정도저화년령소월용역손상。림상급시처리가획량호예후。
Objective To study MRI performance and characteristics of the incomplete closed growth plate injury of knee in the recruits during intensive training .Methods Retrospective analysis was made of MRI of growth plate injury of 36 recruits knees in military training.Tanner’s grading of the growth plate closure degree was used , and adopting S-H (Salter-Harris,S-H) Ⅰ~Ⅶclassi-fication of the growth plate damaged was adopted .Results (1)There were 39 pieces of growth plate injury among 36 cases(knee):10 pieces in the distal femora and 29 pieces in the proximal tibia ,including 6 pieces of 3 cases of the femur and tibia injuries at the same time on them.(2) Tanner’s staging of the closure degree displayed growth plate in 36 recrruits by imaging:19 of 39 were degree 1, 17 were degree 2, 3 were degree 3.(3) S-H classification:2 of 39 were typeⅡ, 5 were typeⅢ, 4 were typeⅣ, 22 were typeⅤand 6 were typeⅥ.There were no typeⅠand type Ⅶ.( 4 ) MRI signal of hemorrhage and edema were displayed in the acute phase of growth plate injury.MRI signals changed with time, could manifest signals of more than short T2, such as T2 and long T2.However, e-dema relieved or subsided in the later , stage and MRI signal displayed a variety of changes with the pathological events such as bleed -ing absorbed , necrosis , cystic degeneration and fiberosis of damaged tissue of growth plate .( 5 ) Followed up by imaging:27 pieces were closed over the same period of the unaffected side in the growth plate injury of 39 pieces .12 pieces of growth plate were asyn-chronously closed (early 4, delayed 8) ,which were the damage of typeⅤ.In shape, 21 pieces were of normal form .The rest of the 18 changed in the form (local bone hypertrophy or similar bone bridge form 9, non-uniform thickness and thinning 9).11 of 18 were the damage of the type Ⅴ.(6)Good clinical prognosis in 29 cases of 36 cases.7 cases with joint deformity (knee varus 2, knee valgus 4, limb slightly shorter 1),they were of typeⅤ.Conclusions The incompletely closed growth plate of knee may be damaged during the recruit military training .Most occurred at the beginning of the training and only one side of knee .Recruits are relatively young , their growth plate closure degree is low and susceptible to injury mostly of type Ⅴ.Timely clinical treatment promises good prognosis .