超声联合弹性成像技术评价2型糖尿病患者跖筋膜异常改变的应用价值

Abnormal changes in plantar fascia of patients with type 2 diabetes mellitus evaluated by ultrasonography combined with elastosonography

目的探讨超声联合弹性成像技术评价2型糖尿病（T2DM）患者足底跖筋膜异常改变的临床应用价值。方法 65例T2DM患者根据其糖尿病病程分为≤10年34例（A组）和〉10年31例（B组）,另选同期健康志愿者38例为对照组。应用高频超声观察各组跖筋膜的内部回声和边界,同时测量跖筋膜距离跟骨结节止点1 cm（PF1）及2 cm（PF2）处的厚度。以PF1、PF2点为中点,长约1 cm的矩形区域为PF1区、PF2区,应用弹性成像技术将跖筋膜PF1区和PF2区的弹性分为1~3级,比较各组弹性分级频数。结果对照组跖筋膜纵切面呈细条状高回声,内可见均匀的平行线样条状高回声,与周围组织界限清晰。A组跖筋膜异常改变13例,B组24例,对照组5例,两两比较差异均有统计学意义（均P〈0.05）;A、B组及对照组PF1厚度两两比较差异均有统计学意义（均P〈0.05）;B组PF2厚度大于对照组（P〈0.05）;A组PF2厚度与对照组和B组比较,差异均无统计学意义。PF1区弹性分级频数比较：1级弹性频数A、B组大于对照组,B组大于A组（均P〈0.05）;2级、3级弹性频数A、B组小于对照组,B组小于A组（均P〈0.05）。PF2区弹性分级频数比较：1级、2级弹性频数A、B组较对照组增加,3级弹性频数减少,差异均无统计学意义。结论超声联合弹性成像技术能够发现T2DM患者足底跖筋膜的异常改变,对糖尿病足的早期预防和诊治具有重要意义。

Objective To explore the clinical value of ultrasonography combined with elastosonography in evaluating the abnormal changes in plantar fascia of patients with type 2 diabetes mellitus（T2DM）.Methods Sixty-five T2 DM patients were enrolled and divided into two groups, including group A（34 cases with course≤10 years）and group B（31 cases with course 〉10 years）.Thirty-eight healthy subjects were enrolled as normal control. The echo texture and border of plantar fascia were observed by high-frequency ultrasonography. The thickness of plantar fascia was measured at its 1 cm and 2 cm distal from insertion locations（PF 1 and PF 2）. The rectangle area with 1 cm length was divided into PF1 and PF2 areas with the midpoints of PF1 and PF2 points. The elasticity of plantar fascia in PF 1 and PF 2 areas was assessed by elastsonoography and classified as 1-3grades, then the grading frequency was compared.Results The ultrasound findings of longitudinal plane of plantar fascia in normal group was displayed as a thin homogeneous hyperechoic band with small parallel lines and well-defined border with surrounding tissue. The rates of abnormality change in group A（13 cases）and group B（24 cases）were higher than that in normal group（5 cases）,and it was higher in group B compared that in group A（P〈0.05）.The thickness of PF 1 in group A and B was larger than that in normal group,and it was larger in group B than group A（P〈0.05）.The PF 2 thickness in group B was larger than that in normal group（P〈0.05）.But there was no significant difference of PF 2 thickness between group A and normal group,group A and group B.The elasticity frequency of grade 1 was increased in group A and group B than that in normal group,and so was it in group B than that in group A（P〈0.05）. And the frequencies of the grade 2 and grade 3 in group A and group B were decreased than those in normal group,and so was it in group B than that in group A（P〈0.05）.There were no significant differences in the elasticity grading of PF 2 area among all the groups（P〈0.05）.Conclusion The abnormal changes in the plantar fascia of T2 DM patients can be evaluated by ultrasonography combined with elastosonography. It has important clinical significance for the early prevention,diagnosis and treatment of diabetic foot.