高频超声在指伸肌腱止点损伤中的诊断价值

Diagnostic value of high frequency ultrasound in extensor tendon insertion injury

目的探讨高频超声在指伸肌腱止点损伤中的诊断价值。方法选取2015年7月至2019年6月在东部战区总医院镇江医疗区经手术证实为手指伸肌腱止点损伤患者58例,年龄5~71岁,其中男性40例,女性18例,分析手指伸肌腱止点损伤患者的超声声像图特点、超声诊断分型及不同超声扫查方法的差异,并与X线检查结果进行对比分析。超声诊断与X线诊断评估手指伸肌腱止点骨性损伤的敏感度、特异度、PPV、NPV、准确性之间差异采用χ^2检验。结果手指伸肌腱止点损伤的超声声像图表现为骨性损伤和腱性损伤2种类型,图像特征表现为82%出现断端回缩增厚、86%出现连续性中断、77%出现回声降低、36%提示撕脱性骨折或基底部骨折、70%动态观察出现断端间距增大;与手术结果相比,高频超声在诊断指伸肌腱止点骨性损伤敏感度为84%、特异度为75.7%、阳性预测值(PPV)为72.4%、阴性预测值(NPV)为86.2%、准确性为79.3%,诊断腱性损伤的敏感度为90.9%、特异度为72%、PPV为81.1%、NPV为85.7%、准确性为82.7%,差异均无统计学意义(P均>0.05),X线检查不能诊断手指伸肌腱止点的腱性损伤;未使用超声耦合垫直接超声扫查与使用超声耦合垫超声扫查诊断指伸肌腱止点损伤,两种扫查方法诊断符合率比较,差异有统计学意义(χ^2=12.645,P=0.001)。结论高频超声能够对指伸肌腱止点损伤的诊断分型,是指伸肌腱止点损伤可靠的影像学检查方法,为临床选择合适的治疗方法提供依据。

Objective To assess the value of high frequency ultrasound in the diagnosis of injury of the extensor tendon insertion.Methods A retrospective analysis was performed on 58 patients(aged 5 to 71 years,including 40 males and 18 females)with finger extensor tendon insertion injury confirmed by surgery at the Zhenjiang Medical District of the Eastern Theater General Hospital from July 2015 to June 2019.The characteristics of ultrasound sonograms,ultrasonic diagnostic typing,and the differences of different ultrasound scanning methods in these patients with finger extensor tendon insertion injury were analyzed and compared with the results of X-ray examination.Results The ultrasonographic features of injury of the finger extensor tendon insertion showed two types:bone injury and tendon injury.The image features were retraction and thickening of broken ends in 82%of cases,continuous discontinuity in 86%,echo reduction in 77%,avulsion fracture or basal fracture in 36%,and increased break distance by dynamic observation in 70%.Using the surgical results as the golden standard,the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of high frequency ultrasound in the diagnosis of bone injury and tendon injury were 84%,75.7%,72.4%,86.2%,and 79.3%,and 90.9%,72%,81.1%,85.7%,and 82.7%,respectively.The differences in the sensitivity,specificity,PPV,NPV,and accuracy of the ultrasound diagnosis versus X-ray diagnosis in assessing bone injury of the finger extensor tendon insertion were not statistically significant(P>0.05).X-ray examination could not diagnose the tendon injury of the finder extensor tendon insertion.The diagnostic coincidence rate between direct ultrasound scan without ultrasound coupling pad and ultrasound scan using ultrasound coupling pad for injury of the extensor tendon insertion was statistically significant(χ^2=12.645,P=0.001).Conclusion High frequency ultrasound can be used to diagnose and type extensor tendon insertion injury.It is a reliable imaging examination method for extensor tendon insertion injury,which provides a basis for clinical selection of appropriate treatment methods.