弹性成像技术在肱骨近端骨折术后疼痛区域组织评定的应用价值

Application value of musculoskeletal ultrasound in the tissue evaluation of pain area after operation of proximal humerus fracture

目的探讨肌骨超声弹性成像技术对肱骨近端骨折术后疼痛区域组织评估价值。方法收集2014年6月-2016年6月间郑州市中心医院院就诊的肱骨近端骨折内固定术后8~12周仍遗留肩疼患者67例:男31例,女36例;左侧19例,右侧41例,双侧7例;肱骨近端骨折neer分型II型48例,III型19例;年龄21岁~41岁,平均年龄(31.19±5.45)岁。术后切口均I/甲愈合,不合并臂丛神经损伤,排除继发因素损伤(糖尿病、甲亢、甲减、心血管疾病、帕金森综合症等系统性疾病)实时给予高频超声弹性成像及MRI检查,随访期间进行为期4周的康复训练,加强患者肩关节内外旋转训练、肌肉等长训练主动抗阻力训练。指导患者屈肘90°,以健侧手作阻力,行患肩关节内外旋转训练,一日两循环,一次100次;行卧位和立位抗重力主动伸臂等训练,一日两循环,一次100次。整个康复训练为期4周。对比物理干预后组织结构改善和VAS评分变化。结果①高频超声UE对人体肌骨病损检查和MRI吻合度高(Kappa=0.74,P=0.000);②弹性成像评分与VAS正相关(相关系数0.996,P=0.004;③。结论肌骨超声UE技术能精确、动态观测肱骨近端骨折术后肩周组织变化,对于肱骨近端骨折术后康复有重要的指导价值。

Objective Real-time dynamic observation of pain tissue in the proximal humerus fractures by musculoskeletal ultrasound showed the advantage of musculoskeletal ultrasound in the tissue evaluation of the metal internal fixation. Methods We collected 67 patients with postoperative pain of proximal humeral fracture from June 2014 to June 2016 in our department.There were 19 cases on the left, 41 cases on the right, and 7 cases on both sides.There were 48 cases of neer type II and 19 cases of neer type III.The average age is(31.19±5.45) years old.Both postoperative incision I/a healing, not merge brachial plexus injury, excluding secondary injury(diabetes, hyperthyroidism, JiaJian, cardiovascular diseases, systemic diseases such as Parkinson’s disease) real-time high-frequency ultrasound elasticity imaging and MRI, for 4 weeks during the follow-up period of rehabilitation training, reinforcing the training of shoulder joint in patients with internal and external rotation, muscle isometric training active resistance training.Guide the patient to bend the elbow 90°, use the healthy side hand as the resistance, and conduct the rotation training of the affected shoulder joint inside and outside, twice a day, 100 times a time;Horizontal and vertical anti-gravity active arm stretching training, two cycles a day, 100 times a time.The entire rehabilitation program lasts four weeks.Comparison of tissue structure improvement and VAS score changes after physical intervention. We gave high-frequency ultrasound elastography and MRI in real time, and randomized a 4-week rehabilitation training to compare tissue structure improvement and VAS score changes after physical intervention. Results ①High-frequency ultrasound has a high degree of coincidence with MRI in human musculoskeletal examination(Kappa=0.74, P=0.000);② The elastography score was positively correlated with VAS(correlation coefficient 0.996, P=0.004);③ Improvement of lesion site after routine physical intervention(94.03%). Conclusion Musculoskeletal ultrasound can accurately and dynamically observe the changes of perihumeral tissue after proximal humeral fracture surgery, which has important guiding value for the postoperative rehabilitation of proximal humeral fracture.