声触诊组织量化技术评价中老年肩峰下撞击综合征患者冈上肌腱的弹性特征

Evaluation of Elastic Characteristics of Supraspinatus Tendon in Middle-Aged and Elderly Patients with Subacromial Impingement Syndrome by Virtual Touch Tissue Imaging Quantification Technique

目的利用声触诊组织量化(VTIQ)技术联合常规超声评价肩峰下撞击综合征(SIS)患者冈上肌腱的形态学及弹性变化。资料与方法纳入41例SIS患者(41个肩关节),按照年龄分为40~59岁组和≥60岁组;另纳入41例性别与年龄相匹配的健康志愿者作为对照组。测量冈上肌腱及肩峰下滑囊的最大厚度,VTIQ技术分别在冈上肌腱距肱骨大结节止点1 cm和1.5 cm处测量肌腱浅层及深层的剪切波速度(SWV),比较不同年龄受试者组间肩峰下滑囊与冈上肌腱厚度,以及肌腱不同深度的SWV。结果不同年龄组SIS患者肩峰下滑囊厚度均大于对照组,差异有统计学意义(P=0.016、P=0.002);40~59岁SIS患者与对照组冈上肌腱厚度差异无统计学意义(P=0.668)。≥60岁SIS患者冈上肌腱厚度大于对照组,差异有统计学意义(P=0.016)。40~59岁SIS患者冈上肌腱SWV低于对照组,差异均有统计学意义(P浅层=0.020、P深层=0.007)。≥60岁SIS患者与对照组冈上肌腱SWV比较,差异均无统计学意义(P浅层=0.513、P深层=0.926)。不同年龄组中,SIS组及对照组冈上肌腱浅层SWV均低于深层SWV,差异均有统计学意义(P<0.05)。结论肩峰下滑囊增厚是SIS的形态学特征之一。SIS及年龄≥60岁均可导致冈上肌腱软化;且冈上肌腱不同深度存在弹性差异。超声弹性成像可敏感地量化肌腱机械性能,提供术前评估和预后监测肌腱机械性能定量的辅助信息。

Purpose To evaluate the morphologic and elastic changes to supraspinatus tendon in patients with subacromial impingement syndrome(SIS)by virtual touch tissue imaging quantification(VTIQ)combined with conventional ultrasound.Materials and Methods Forty-one patients with SIS(41 shoulder joints)included in the study were divided into 40-59 years old group and≥60 years old group;41 healthy volunteers with matching gender and age were additionally included as control group.The maximum thickness of supraspinatus tendon and subacromial bursa was measured.The shear wave velocities(SWV)of the superficial and deep layers of tendon were measured by VTIQ technique at 1 cm and 1.5 cm from the supraspinatus tendon to the stop of the greater tubercle of humerus.The thickness of the subacromial bursa and supraspinatus tendon and the SWV of supraspinatus tendon at different depths were compared between the groups of different ages.Results In groups of different ages,the thickness of the subacromial bursa in SIS group was larger than that in the control group,and the difference was statistically significant(P=0.016,P=0.002).In 40-59 years old group,there was no significant difference in the thickness of supraspinatus tendon between the SIS group and the control group(P=0.668),but in the≥60 years old group,the thickness of the supraspinatus tendon in the SIS group was greater than that in the control group,and the difference was statistically significant(P=0.016).In 40-59 years old group,SWV of supraspinatus tendon in the SIS group was lower than that in the control group and the difference was statistically significant(Psuperficial=0.020,Pdeep=0.007).In≥60 years old group,there was no significant difference in SWV between the SIS group and the control group(Psuperficial=0.513,Pdeep=0.926).In groups of different ages,the superficial layer SWV of supraspinatus tendon was lower than deep layer SWV in the SIS group and the control group(P<0.05).Conclusion The thickening of subacromial bursa is one of the morphologic features of SIS.SIS and age≥60 years old could result in the softening of supraspinatus tendon,and there are elastic differences in different depths of supraspinatus tendon.Ultrasonic elastography could sensitively quantify the mechanical properties of tendon and provide auxiliary information on preoperative evaluation and prognosis monitoring of quantification of mechanical properties of tendon.