超声弹性成像在冈上肌肌腱炎的诊断及预后评估中的应用价值

Application of ultrasound elastography in the diagnosis and prognosis evaluation of supraspinatus tendinitis

目的:探讨超声弹性成像在冈上肌肌腱炎的诊断及预后评估中的应用价值。方法:选择冈上肌肌腱炎患者80例为研究对象。所有患者治疗前后均接受冈上肌肌腱的声辐射力脉冲(ARFI)弹性成像检查,记录剪切波速度(SWV)值。并使用视觉模拟评分(VAS),Constant-Murley肩关节功能评分(CMS)评估患者疼痛情况及肩关节功能的改善情况。所有患者进行为期1年的随访,将出现终点事件的患者定义为复发组,其余患者定义为未复发组。分析两组患者随访开始前VAS、CMS及SWV值对患者预后的预测价值。结果:治疗后VAS、SWV值低于治疗前,CMS高于治疗前,差异均有统计学意义(P值均<0.05)。治疗前SWV与VAS无相关性(r=0.073,P=0.518),与CMS呈负相关(r=-0.305,P=0.006)。随访不良预后的发生率为36.25%。VAS、CMS及SWV三项指标单独预测冈上肌肌腱炎预后的曲线下面积(AUC)分别为0.776、0.763、0.850,三者联合预测的AUC为0.949,显著大于三项指标单独预测的AUC(联合vs SWV:Z=2.898,P=0.004;联合vs VAS:Z=3.583,P=0.000;联合vs CMS:Z=3.722,P=0.000),其敏感度为89.66%,特异度为92.16%。结论:ARFI可用于冈上肌肌腱炎的诊断,VAS、CMS及SWV的联合可准确预测冈上肌肌腱炎的预后。

Objective: To explore the value of ultrasound elastography in the diagnosis and prognosis evaluation of supraspinatus tendinitis. Methods: Eighty patients with supraspinatus tendinitis were recruited as subjects.All patients underwent acoustic radiation force impulse (ARFI) elastography of the supraspinatus tendon before and after treatment,and shear wave velocity (SWV) values were recorded.The visual analog scale (VAS) and the constant-murley shoulder function score (CMS) were used to assess the patient's improvement in pain and shoulder function.All patients underwent a one-year followvup,and patients with endpoint events were defined as a recurrent group,and the remaining patients were defined as a non-recurrent group.The predictive value of VAS,CMS and SWV values before the beginning of follow-up was analyzed. Results: The VAS and SWV values after treatment were lower than those before treatment,and CMS was higher than that before treatment (all P <0.05).There was no correlation between SWV and VAS before treatment ( r =0.073, P =0.518),and negatively correlated with CMS ( r =-0.305, P =0.006).The poor prognosis rate of supraspinatus tendinitis at follow-up was 36.25%.The area under the curve (AUC) for predicting the prognosis of supraspinatus tendonitis by VAS,CMS and SWV was 0.776,0.763 and 0.850,respectively.The combined AUC of the three was 0.949,which was significantly larger than the AUC predicted by the three indicators alone (Combined vs. SWV: Z =2.898, P =0.004,Combined vs.VAS: Z =3.583, P <0.001,Combined vs.CMS: Z =3.722, P <0.001),with a sensitivity of 89.66% and a specificity of 92.16%. Conclusion: ARFI can be used for the diagnosis of supraspinatus tendinitis.The combination of VAS,CMS and SWV can accurately predict the prognosis of supraspinatus tendinitis.