- 期刊
使用超音波診斷被忽略的幼兒股骨骨折：病例報告
Ultrasonography Diagnosis of a Neglected Femoral Fracture in a Child: A Case Report
摘要
對於孩童和嬰幼兒骨折，超音波已被報告過為無痛，快速，易於操作，免於放射線暴露，又有極高的敏感性的工具，來偵測臨床上不易診斷的小兒不完全骨折，鎖骨骨折或是尚未骨化完全(unossified)部位的骨折，以及作為嬰幼兒骨折復原的追蹤。 本篇報告是一例一歲五個月大的幼兒，因拉扯傷後左大腿處有一疼痛腫塊，起初至急診求診時被認為是肌肉拉傷。其父母又帶他去骨科診所求診，仍被視為拉傷處理，當時此幼兒已可以自行走路，可是左大腿處腫塊依然存在，因此被轉至本院小兒骨科門診。骨科醫師安排此幼兒至本科進行骨骼肌肉超音波檢查，在超音波檢查下發現不連續的骨皮質(cortical disruption)及不規則高回音(irregular hyperechoic)於不連續骨的表面。在懷疑有骨折的狀況下，骨科醫師再為幼兒安排放射線攝影，進而發現為不移位的股骨骨折(non-displaced)且已有骨痂(callus)形成。此時距離受傷已五週，已錯失早期固定(immobilization)的時機。在四週後的追蹤發現在超音波下已無不連續骨皮質且整個骨表面十分平滑，與追蹤的X光片結果一致。 藉報告此病例來強調對於症狀不明確，不能配合檢查又難以表達的孩童，使用超音波診斷潛在骨折以及日後追蹤，應該作為安排檢查的第一線選擇，免於放射線暴露也免於耽誤治療時機。
並列摘要
Ultrasonography is sensitive and reliable for detecting pediatric fractures, including incomplete fractures, clavicle fractures, and fractures in unossified bones. Ultrasonography is also a good imaging modality for pediatric bone healing. A 1-year-5-month-old boy suffered from a painful mass on the left thigh due to a traction injury. His parents brought him to the emergency room, and the initial impression was soft tissue injury. The patient presented with disabling pain and was unable to walk for a few days following the injury. Ultrasonography was scheduled and revealed cortical disruption of the femoral shaft with irregular hyperechoic materials over the area of cortical disruption. Under the impression of the femoral fracture, radiography was performed, which showed a non-displaced femoral shaft fracture with callus formation. Four weeks later (8 weeks after injury), ultrasound examination revealed a smooth cortical bone surface, which was highly correlated with radiography findings. Ultrasonography can be the first imaging study performed for suspected occult fracture and to observe subsequent bone union in uncooperative children.
延伸閱讀
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