高频超声监测跟腱断裂术后康复治疗期断端动态变化的研究

Study on the dynamic changes of the broken end during rehabilitation period after the repair of Achilles tendon rupture by high frequency ultrasound

目的探讨高频超声技术对运动损伤跟腱断裂术后康复治疗检测的应用价值。方法选取东莞市康复医院2016年3月至2017年3月收治的30例行跟腱断裂术治疗的患者作为研究对象,运用高频超声二维灰阶(2D)成像技术观察跟腱的内部回声,包膜连续性、断端连接处回声,并采用轨迹面积测量法测量跟腱横断面积;运用高频超声彩色多普勒(CDFI)成像及增强型血流成像(e FLOW)技术观察跟腱断端连接处的血流分布及数量。结果 2D超声成像结果显示,术后4周时,患者跟腱断端可见明显的高低不等回声填充征兆,两端跟腱回声、增粗较健侧偏低;术后8周时,患者跟腱断端回声趋向正常,可见整齐排列的清晰纤细束状高回声排列;术后12周时,患者跟腱断端回声均匀,且两端跟腱明显变细;术后24周时及一年时,患者断端回声与健侧回声信号基本相同;CDFI及e FLOW显像结果结果显示,手术4周时可见跟腱断端明显血流信号,术后8周及12周时跟腱断端无明显血流信号,手术24周及1年时跟腱断端无血流信号;相较于健侧,患侧距跟骨结节不同测量点跟腱周长均偏高,且差异均有统计学意义(P<0.05);随着术后随访时间的延长,患者距跟骨结节随着由近及远距离,其跟腱超声监测周长逐渐变小,且差异有统计学意义(P<0.05)。结论采用高频超声对跟腱断裂术后进行动态监测,可在康复治疗期有效评估断端动态变化。

Objective To explore the application value of high frequency ultrasound in the rehabilitation treatment of Achilles tendon rupture after movement injury. Methods A total of 30 patients who underwent repair of Achilles tendon rupture in Dongguan Rehabilitation Hospital from March 2016 to March 2017 were selected as the research subjects. Gray-scale ultrasound（2 D） was used to observe the internal echo of the Achilles tendon, coated continuity, and the echo of broken ends. Track measurement area was used to measure the cross-sectional area of Achilles tendon. High frequency color Doppler flow imaging（CDFI） imaging and enhanced blood flow imaging（e FLOW） technique were used to observe the distribution and number of blood flow at the joint of the broken ends of Achilles tendon. Results 2 D ultrasound imaging results showed that 4 weeks after operation, there were obvious signs of unequal echo filling in the broken ends of fractured bone of the Achilles tendon. The echo of both ends of the Achilles tendon was lower than that of the healthy side. Eight weeks after operation, the echo of the broken ends tended to be normal, and a clear, fine bundle of hyperechoic arrangement was observed. Twelve weeks after operation, the Achilles tendon had homogenous echo, and the two ends of the Achilles tendon was significantly thinner. Twenty-four weeks after the operation and one year, the echo signal of the broken ends was basically the same as that of the normal side. The results of CDFI and e FLOW showed that the blood flow signal was obvious in the broken end of the Achilles tendon at 4 weeks after operation, and no obvious blood flow signal was found at the broken ends at 8 and 12 weeks after operation, with no blood flow signal at the broken ends at 24 weeks and 1 year after operation. The circumference of the Achilles tendon at different measurement points of the diseased side was significantly higher than that of the healthy side（P〈0.05）. With the prolongation of postoperative follow-up time, the circumference of the Achilles tendon monitored by ultrasound became smaller with the distance from the proximal to the distant of calcaneal tubercle, and the difference was statistically significant（P〈0.05）.Conclusion The dynamic monitoring of the Achilles tendon rupture by high frequency ultrasound can effectively evaluate the dynamic changes of the broken end in the rehabilitation period.