超声检查在下肢远端骨折患者肌肉参数及血流动力学改变监测中的应用

Application of ultrasound in monitoring changes in quadriceps muscle parameters and hemodynamics in patients with distal leg fractures

目的应用超声测量下肢膝关节以下远端骨折患者股四头肌(股直肌、股中间肌、股外侧肌、股内侧肌)形态结构参数和下肢股动脉血流动力学参数,探讨这些参数随时间变化与废用性肌萎缩之间的关系。方法选取2018年5月至2019年5月在昆山市周市人民医院就诊的20例需要卧床制动的下肢远端骨折患者,分为观察组患侧、观察组健侧。观察组入院第1、4、7、10天超声检测双侧下肢股直肌面积、股四头肌厚度及股动脉血流频谱参数,共4次,观察这些数据随时间的变化情况。同时,分别将观察组患侧与健侧股动脉血流频谱参数第10天与第1天比较。结果观察组患侧与健侧4个时间点肌肉厚度数值比较呈逐渐下降趋势,即发生了肌肉萎缩,股直肌厚度及面积比较,差异均有统计学意义(t=4.436、11.506、2.175、5.902、11.784、5.949、16.620、14.069、4.904、5.726、9.787,P均<0.05),股外侧肌厚度比较,差异均有统计学意义(t=4.682、5.978、4.133、4.608、7.092,P均<0.05)、股中间肌厚度比较,差异均有统计学意义(t=3.784、5.669、3.916、10.128、12.271,P均<0.05)、股内侧肌厚度比较,差异均有统计学意义(t=7.166、3.443、4.983、2.978,P均<0.05);患侧股内侧肌制动后萎缩时间最早,于第4天开始。患侧健侧股动脉血流频谱参数第10天与第1天比较:舒张早期反向血流速度降低,舒张早期反向血流持续时间缩短,差异均有统计学意义(t=5.337、3.246、3.604、2.484,P均<0.05)。患侧股动脉4个时间点数值比较:收缩期峰值速度逐渐下降,舒张早期反向血流速度逐渐降低,舒张早期反向血流持续时间逐渐缩短,差异均有统计学意义(t=2.633、4.711、5.337、4.681、3.246、4.574、2.973、3.604、2.484、2.484,P均<0.05)。结论超声可以通过肌肉的厚度面积变化和血流动力学改变评估肌肉萎缩情况。

Objective To measure the morphological parameters of the quadriceps(rectus femoris,medial femoral muscle,lateral femoral muscle,and medial femoral muscle)and the changes in hemodynamic parameters of the lower extremity femoral artery in patients with distal extremity fractures by ultrasound and to explore the relationship between these parameters and the disuse muscle atrophy and provide reference for early clinical rehabilitation.Methods Twenty patients with distal extremity fractures requiring bed rest who were treated at Kunshan Zhoushi people′s Hospital from May 2018 to May 2019 were included.Both the affected side and the healthy side were observed.The rectus femoris thickness and area,quadriceps thickness,and femoral artery blood flow spectrum parameters of the lower extremities were repeatedly measured by ultrasound on the first,fourth,seventh,and tenth days since hospital admission to observe the changes in these data over time.The femoral artery blood flow spectrum parameters on day 1 were also compared with those on day 10.Results Compared with the healthy side,the affected side had significantly decreased rectus femoris thickness and area(t=4.436,11.506,2.175,5.902,11.784,5.949,16.620,14.069,4.904,5.726,and 9.787,P<0.05),lateral femoral muscle thickness(t=4.682,5.978,4.133,4.608,and 7.092,P<0.05),medial femoral muscle thickness(t=3.784,5.669,3.916,10.128,and 12.271,P<0.05),and medial femoris thickness(t=7.166,3.443,4.983,2.978,all P<0.05),suggesting that muscle atrophy occurred in the affected side.The atrophy occurred earliest on the 4 th day after the ipsilateral medial femoral muscle was braked.In the early diastolic phase,the reverse blood flow velocity on day 10 was significantly reduced compared with that on day 1 and the duration of reverse blood flow was significantly shortened(t=5.337,3.246,3.604,and 2.484,P<0.05).When comparing the parameters of the affected femoral artery among the four time points,the peak velocity in the systolic phase,the reverse blood flow velocity in the early diastolic phase,and the duration of the reverse blood flow in the early diastolic phase all decreased significantly(t=2.633,4.711,5.337,4.681,3.246,4.574,2.973,3.604,2.484,and 2.484,P<0.05).Conclusion Ultrasound can assess muscle atrophy by monitoring the changes in muscle thickness and hemodynamic changes.