肱二头肌远端肌腱的高频超声扫查方法

Direct and Indirect Methods of High-frequency Ultrasound in Imaging Distal Biceps Brachii Tendon

目的探寻可清晰显示肱二头肌远端肌腱的便捷有效的超声扫查方法和技巧。方法分别采用高频超声直接法和间接法扫查40例健康志愿者的双侧共80条肱二头肌远端肌腱,记录扫查时间,调查受检者的主观舒适度,评估肱二头肌远端肌腱主干及止点的显示清晰度,并进行比较分析。结果全体志愿者、男性志愿者及女性志愿者中超声间接法扫查肱二头肌远端肌腱的时间均较直接法短,但差异均无统计学意义(P均> 0. 05)。两种方法扫查肱二头肌远端肌腱的时间左侧均大于右侧,差异也均无统计学意义(P均> 0. 05)。除左侧直接法男女所用时间差异无统计学意义外(t=-1. 27,P=0. 213),女性左侧间接法(t=-2. 33,P=0. 025)、右侧直接法(t=-3. 35,P=0. 002)和右侧间接法(t=-2. 67,P=0. 011)所用时间均明显小于男性。全体志愿者、男性志愿者和女性志愿者中超声直接法扫查肱二头肌远端肌腱受检者主观舒适度评分与间接法相比差异均无统计学意义(P均> 0. 05)。无论哪种方法扫查肱二头肌远端肌腱受检者主观舒适度均为右侧大于左侧,其中,在女性间接法(t=2. 52,P=0. 021)、全体直接法(t=2. 32,P=0. 026)和间接法(t=3. 08,P=0. 004)中这种差异具有统计学意义。女性志愿者总体主观舒适度评分高于男性志愿者,其中,右侧直接法的差异具有统计学意义(t=2. 33,P=0. 025),右侧间接法(t=2. 00,P=0. 053)、左侧直接法(t=0. 34,P=0. 739)和左侧间接法(t=-0. 15,P=0. 884)差异均无统计学意义。间接法检查右侧和左侧肱二头肌远端肌腱止点的显示清晰率分别为100. 0%和95. 0%,均明显高于直接法的85. 0%(P=0. 026)和60. 0%(P=0. 000),检查右侧和左侧肱二头肌远端肌腱主干的显示清晰率分别100. 0%和92. 5%,与直接法的95. 0%(P=0. 494)和87. 5%(P=0. 712)差异均无统计学意义。结论高频超声采用直接法和间接法扫查肱二头肌远端肌腱时所用时间和受检者主观舒适度相似,间接法对止点的显示清晰率更高,可作为首选检查方法,而直接法可作为补充检查手段。

Objective To explore convenient and effective ultrasound scanning methods and skills for imaging the distal biceps tendon.Methods Totally 80 distal biceps tendons of 40 healthy volunteers were scanned and evaluated with high-frequency ultrasound using the direct and the indirect methods.The scanning time and the subjective comfort scores of each subject were recorded.The imaging clarity of the tendon and its insertion onto the radial tuberosity was evaluated.Results The scanning time of the indirect method was shorter than that of the direct method in all volunteers,male volunteers,and female volunteers,although the differences were not statistically significant(all P﹥0.05).The mean scanning time was longer on the left side than on the right side regardless of the scanning method(all P﹥0.05).The scanning time in women was significantly shorter than in men when the scan was performed by using indirect method on the left side(t=-2.33,P=0.025),direct method on the right side(t=-3.35,P=0.002),or indirect method on the right side(t=-2.67,P=0.011).However,the scanning time was not significantly different between women and men when using the direct method on the left side(t=-1.27,P=0.213).The subjective comfort score was not significantly different between direct and indirect methods in each group(allP﹥0.05).However,the subjective comfort score was higher on the right side than on the left side regardless of the methods used.In particular,the subjective comfort scores showed significant difference when using the direct method in all subjects(t=2.32,P=0.026),the indirect method in all subjects(t=3.08,P=0.004),and indirect method in females(t=2.52,P=0.021).The overall subjective comfort score of females was higher than that of males,and the difference was statistically significant when the direct method was used on the right side(t=2.33,P=0.025),although no significant difference was observed for the indirect method on the right side(t=2.00,P=0.053),direct method on the left side(t=0.34,P=0.739),and indirect method on the left side(t=-0.15,P=0.884).The clarity rates of the indirect method for the insertions were 100.0%and 95.0%,which were significantly higher than those of the direct method(right side:100.0%vs.85.0%,P=0.026;left side:95.0%vs.60.0%,P=0.000).The clarity rates of the main trunk of the tendon showed no significant difference between direct and indirect methods on both sides(right side:100.0%vs.95.0%,P=0.494;left side:92.5%vs.87.5%,P=0.712).Conclusions When high-frequency ultrasound is applied for scanning the distal biceps tendon,the scanning time and the subjective comfort are similar when either the direct method or the indirect method is used.The indirect method has higher clarity in imaging the insertion and may be used as the preferred scanning method,whereas the direct method may serve as a supplementary method.