Lin Lijun,Wu Xing,Xia Jingdong,et al.Superb microvascular imaging characteristics and clinical significance of femoral head microcirculation in infants[J].Journal of Clinical Pediatric Surgery,2024,(07):653-658.[doi:10.3760/cma.j.cn101785-202403008-009]
婴幼儿股骨头微循环的超微血管成像特征及临床意义
- Title:
- Superb microvascular imaging characteristics and clinical significance of femoral head microcirculation in infants
- Keywords:
- Femoral Head Haemodynamics; Superb Microvascular Imaging; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探索超微血管成像评估婴幼儿股骨头血运的可行性及其图像特征。方法 本研究为回顾性研究,选取2023年4月在武汉儿童医院骨科行健康筛查的18例婴儿(男11例、女7例)作为研究对象,日龄(51.1±38.7)d,均在安静状态下行髋关节超声检查。从髋关节外侧横切面与纵切面两个方向上进行检查,先使用灰度超声观察股骨头的解剖特点,然后采用超微血管成像显示股骨头内血流情况,测量血管收缩期峰值血流速度。结果 18例婴儿股骨头横切面灰度超声图像均可见明显交替低回声与条纹回声,条纹向股骨头中心汇聚,纵切面灰度超声图像上可见股骨头与大转子中的点状或条纹回声。在股骨头的超微血管成像图中,均可显示股骨头内血流,横切面上观察到血流向骨化中心汇聚;在纵切面上观察到股骨头血供主要有两个来源:一处来自股骨干骺端,穿越骺板,垂直于骺板走行在股骨头内;另一处来自旋股内侧动脉后上支,其分支略平行于骺板走行在股骨头内。除1例婴儿检查时受到杂波干扰外,余17例婴儿均可测得旋股内侧动脉后上支收缩期峰值血流速度,为(10.9±4.3)cm/s。比较男性、女性之间旋股内侧动脉后上支收缩期峰值血流速度,差异无统计学意义。旋股内侧动脉后上支收缩期峰值血流速度与体重呈显著正相关(r=0.531,P=0.028)、与日龄呈显著正相关(r=0.775,P＜0.001)。进行线性回归分析,旋股内侧动脉后上支收缩期峰值血流速度与日龄、体重的线性拟合程度均较高。结论 本研究初步证明了超微血管成像技术可用于评估婴儿股骨头的血运。
- Abstract:
- Objective To explore the feasibility and image characteristics of superb microvascular imaging (SMI) for assessing femoral head blood flow in infants and toddlers.Methods There were 11 boys and 7 girls with an age range of (51.1±38.7) day.In April 2023,anatomical characteristics of femoral head were observed by gray-scale ultrasonography in a quiet state.And SMI was utilized for measuring peak systolic blood flow velocity of vessels.Results Alternating hypoechogenicity and striated echogenicity appeared on gray-scale ultrasonic images of transverse section of femoral head.There was converging to the center of femoral head.Punctate or striated echoes in femoral head and greater trochanter were noted on longitudinal scans.Blood flow in femoral head converged to ossification center on transverse scan.Blood supply to femoral head on longitudinal scan came from two major sources:one from femoral metaphysis,crossing physeal plate,running perpendicular to physeal plate in femoral head;and the other from posterosuperior branch of pinning medial femoral artery with branches slightly parallel to physeal plate in femoral head.Peak systolic velocity of posterosuperior branch of medial femoral artery was (10.9±4.3) cm/s in 17 infants except one case was disturbed by clutter during examination.No significant difference existed in peak systolic blood flow velocity between males and females in posterosuperior branch of medial circumflex femoral (MCF) artery (P=0.791).Peak systolic velocity of posterosuperior branch of MCF artery was significantly correlated positively with body weight (r=0.531,P=0.028) and age (r=0.775,P<0.001).Linear regression analysis was performed,and peak systolic blood flow velocity of posterior superior branch of MCF artery was linearly fitted with age and body weight .Conclusions SMI may be employed for assessing blood supply to femoral head in infants and toddlers.
参考文献/References:
[1] 刘万林,孙亮,赵振群,等.骨化核与发育性髋关节发育不良闭合复位后股骨头缺血坏死相关性的研究进展[J].临床小儿外科杂志,2023,22(6):584-587.DOI:10.3760/cma.j.cn101785-202010041-017. Liu WL,Sun L,Zhao ZQ,et al.Research advances on the relationship of ossification nucleus with avascular necrosis of developmental hip dysplasia after closed reduction[J].DOI:10.3760/cma.j.cn101785-202010041-017.
[2] Malvitz TA,Weinstein SL.Closed reduction for congenital dysplasia of the hip.Functional and radiographic results after an average of thirty years[J].J Bone Joint Surg Am,1994,76(12):1777-1792.DOI:10.2106/00004623-199412000-00004.
[3] Brougham DI,Broughton NS,Cole WG,et al.Avascular necrosis following closed reduction of congenital dislocation of the hip.Review of influencing factors and long-term follow-up[J].J Bone Joint Surg Br,1990,72(4):557-562 DOI 10.1302/0301-620X.72B4.2380203.
[4] 郝政,蒋青.发育性髋关节脱位治疗后并发股骨头坏死的研究现状及进展[J].中华小儿外科杂志,2013,34(4):304-307.DOI:10.3760/cma.j.issn.0253-3006.2013.04.017. Hao Z,Jiang Q.Current research status and advances of femoral head necrosis after a treatment of developmental hip dislocation[J].Chin J Pediatr Surg,2013,34(4):304-307.DOI:10.3760/cma.j.issn.0253-3006.2013.04.017.
[5] Wu JP,Yuan Z,Li JC,et al.Does the vascular development of the femoral head correlate with the incidence of avascular necrosis of the proximal femoral epiphysis in children with developmental dysplasia of the hip treated by closed reduction?[J].J Child Orthop,2021,15(4):395-401.DOI:10.1302/1863-2548.15.210059.
[6] Haruno LS,Kan JH,Rivlin MJ,et al.Spica MRI predictors for epiphyseal osteonecrosis after closed reduction treatment of dysplasia of the hip[J].J Pediatr Orthop B,2019,28(5):424-429.DOI:10.1097/BPB.0000000000000606.
[7] Tiderius C,Jaramillo D,Connolly S,et al.Post-closed reduction perfusion magnetic resonance imaging as a predictor of avascular necrosis in developmental hip dysplasia:a preliminary report[J].J Pediatr Orthop,2009,29(1):14-20.DOI:10.1097/BPO.0b013e3181926c40.
[8] Jaramillo D,Villegas-Medina O,Laor T,et al.Gadolinium-enhanced MR imaging of pediatric patients after reduction of dysplastic hips:assessment of femoral head position,factors impeding reduction,and femoral head ischemia[J].AJR Am J Roentgenol,1998,170(6):1633-1637.DOI:10.2214/ajr.170.6.9609187.
[9] 刘波,沈鑫,张雪梅,等.超微血管成像技术在儿童睾丸血流检测中的应用价值[J].医学影像学杂志,2019,29(9):1539-1542. Liu B,Shen X,Zhang XM,et al.Application value of superb microvascular imaging in evaluating testicular blood flow in children[J].J Med Imaging,2019,29(9):1539-1542.
[10] Canning DA.Re:feasibility of superb microvascular imaging to detect high-grade vesicoureteral reflux in children with urinary tract infection[J].J Urol,2019,201(2):217.DOI:10.1097/01.JU.0000553029.35477.3d.
[11] Kim HK,O’Hara S,Je BK,et al.Feasibility of superb microvascular imaging to detect high-grade vesicoureteral reflux in children with urinary tract infection[J].Eur Radiol,2018,28(1):66-73.DOI:10.1007/s00330-017-4974-x.
[12] Lee YS,Kim MJ,Han SW,et al.Superb microvascular imaging for the detection of parenchymal perfusion in normal and undescended testes in young children[J].Eur J Radiol,2016,85(3):649-656.DOI:10.1016/j.ejrad.2015.12.023.
[13] Ohno Y,Fujimoto T,Shibata Y.A new era in diagnostic ultrasound,superb microvascular imaging:preliminary results in pediatric hepato-gastrointestinal disorders[J].Eur J Pediatr Surg,2017,27(1):20-25.DOI:10.1055/s-0036-1593381.
[14] Yousefzadeh DK,Ramilo JL.Normal hip in children:correlation of US with anatomic and cryomicrotome sections[J].Radiology,1987,165(3):647-655.DOI:10.1148/radiology.165.3.3317497.
[15] Graf R.The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment[J].Arch Orthop Trauma Surg (1978),1980,97(2):117-133.DOI:10.1007/BF00450934.
[16] 侯佩伺,刘万林,赵振群,等.髋关节超声筛查及筛查体系在婴幼儿发育性髋关节发育不良早期诊断中的应用进展[J].临床小儿外科杂志,2023,22(5):480-484.DOI:10.3760/cma.j.cn101785-202211058-015. Hou PS,Liu WL,Zhao ZQ,et al.Application of ultrasonic screening of hip joint and screening system in an early diagnosis of infantile developmental hip dysplasia[J].J Clin Ped Sur,2023,22(5):480-484.DOI:10.3760/cma.j.cn101785-202211058-015.
[17] Schwartz DS,Keller MS,Fields JM,et al.Arterial waveforms in the femoral heads of healthy neonates[J].AJR Am J Roentgenol,1998,170(2):465-466.DOI:10.2214/ajr.170.2.9456965.
[18] Barnewolt CE,Shapiro F,Jaramillo D.Normal gadolinium-enhanced MR images of the developing appendicular skeleton:Part I.Cartilaginous epiphysis and physis[J].AJR Am J Roentgenol,1997,169(1):183-189.DOI:10.2214/ajr.169.1.9207522.
[19] Yousefzadeh DK,Doerger K,Sullivan C.The blood supply of early,late and nonossifying cartilage:preliminary gray-scale and Doppler assessment and their implications[J].Pediatr Radiol,2008,38(2):146-158.DOI:10.1007/s00247-007-0655-2.
[20] Goeral K,Hojreh A,Kasprian G,et al.Microvessel ultrasound of neonatal brain parenchyma:feasibility,reproducibility,and normal imaging features by superb microvascular imaging (SMI)[J].Eur Radiol,2019,29(4):2127-2136.DOI:10.1007/s00330-018-5743-1.
[21] Hasegawa J,Suzuki N.SMI for imaging of placental infarction[J].Placenta,2016,47:96-98.DOI:10.1016/j.placenta.2016.08.092.
[22] 杨凡,程文.超声微血管成像技术的研究进展[J].现代肿瘤医学,2022,30(8):1524-1527.DOI:10.3969/j.issn.1672-4992.2022.08.039. Yang F,Cheng W.Research advances of ultrasonic micro-vascular imaging[J].J Mod Oncol,2022,30(8):1524-1527.DOI:10.3969/j.issn.1672-4992.2022.08.039.
[23] 刘永轶,胡俊清,钟震亚,等.股骨头颈骨内、外静脉回流的解剖学研究[J].中国临床解剖学杂志,2002,20(6):431-434.DOI:10.3969/j.issn.1001-165X.2002.06.010. Liu YY,Hu JQ,Zhong ZY,et al.Anatomy of intra/extra-osteal venous reflux in femoral head and neck[J].Chin J Clin Anat,2002,20(6):431-434.DOI:10.3969/j.issn.1001-165X.2002.06.010.
[24] Trueta J.The normal vascular anatomy of the human femoral head during growth[J].J Bone Joint Surg Br,1957,39-b(2):358-394.DOI:10.1302/0301-620X.39B2.358.
[25] Yousefzadeh DK,Jaramillo D,Johnson N,et al.Biphasic threat to femoral head perfusion in abduction:arterial hypoperfusion and venous congestion[J].Pediatr Radiol,2010,40(9):1517-1525.DOI:10.1007/s00247-010-1602-1.
[26] Jaramillo D,Villegas-Medina OL,Doty DK,et al.Gadolinium-enhanced MR imaging demonstrates abduction-caused hip ischemia and its reversal in piglets[J].AJR Am J Roentgenol,1996,166(4):879-887.DOI:10.2214/ajr.166.4.8610567.
[27] Nguyen JC,Back SJ,Barrera CA,et al.Developmental dysplasia of the hip:can contrast-enhanced MRI predict the development of avascular necrosis following surgery?[J].Skeletal Radiol,2021,50(2):389-397.DOI:10.1007/s00256-020-03572-z.
备注/Memo
收稿日期:2024-3-7。
基金项目:湖北省重点研发计划项目(2021BCA140); 湖北省自然科学基金项目(2022CFB460)
通讯作者:沈先涛,Email:xiantaoshen9815@aliyun.com