基于经筋理论膝骨关节炎常见经筋病灶点的超声解剖学及针刀入路研究

Ultrasound anatomy and needle-knife insertion approach of common tendon lesions in knee osteoarthritis based on meridian sinew theory

目的:探讨膝骨关节炎(KOA)常见经筋病灶点超声解剖特征及针刀入路,为基于经筋理论针刀循经筋病灶点精准松解治疗KOA提供依据。方法:选取60例单膝患病KOA患者,采用高频肌骨超声在双膝常见经筋病灶点"鹤顶次""髌外下""髌内下""阴陵上"解剖位置上采集声像图,在声像图上标注解剖层次,对比分析病变好发解剖层面和病灶声像特征,并测量针刀模拟入路相关数据。结果:"鹤顶次"病变好发解剖层面在股四头肌肌腱髌骨附着处和髌上囊;"髌外下""髌内下"病变好发解剖层面分别在髌外、内侧支持带髌骨附着处和髌下脂肪垫;"阴陵上"病变好发解剖层面在鹅足腱胫骨内髁附着处和鹅足滑囊。以"鹤顶次"为例,针刀松解进针点为髌骨正上缘上1 cm,松解股四头肌肌腱髌骨附着处,平均进针深度为(3.60±0.10)cm,针体垂直皮肤90°;松解髌上囊平均进针深度为(2.35±0.17)cm,针体向头侧偏45°。结论:肌骨超声能够清晰呈现KOA常见经筋病灶点局部精细解剖层次、病变超声特征和好发解剖层面,可提高针刀循经筋病灶点非直视下松解治疗KOA的精准度,对针刀医学标准化和规范化操作具有重要参考价值。

Objective To explore the ultrasonic anatomical characteristics and needle-knife insertion approach of common tendon lesions in knee osteoarthritis(KOA), so as to provide the references for accurate release of KOA by needleknife along tendon lesions based on meridian sinew theory. Methods Sixty patients with one-knee KOA were selected. High-frequency musculoskeletal ultrasound was used to collect sonograms at the anatomical positions of "Hedingci" "Binwaixia" "Binneixia" and "Yinlingshang". The anatomic levels were marked on the sonograms. The anatomic levels and sonographic features of lesions were compared and analyzed, and the relevant data of needle-knife simulation approach was measured. Results The "Hedingci" lesions were mainly located at the attachment of quadriceps tendon to patella and suprapatellar bursa. The "Binwaixia" and "Binneixia" lesions were mainly located at the attachment of retinaculum patellae laterale and retinaculum patellae mediale to patella and infrapatellar fat pad. The "Yinlingshang" lesions were mainly located at the attachment of goose foot tendon to medial tibial condyle and bursa of goose foot. With "Hedingci" as an example, when the needle-knife entry point was 1 cm above the patella, the attachment of quadriceps tendon to patella was released, and the average depth of needle-knife was(3.60±0.10) cm, and the needle body was perpendicular to the skin. The average depth of needle-knife for releasing suprapatellar bursa was(2.35±0.17) cm, and the needle body was 45° towards head. Conclusion The musculoskeletal ultrasound could clearly show the local detailed anatomical level, ultrasonic characteristics and anatomical level of common tendon lesions of KOA, and could improve the accuracy of needle-knife along tendon lesions with non-direct vision, which has important reference value for needle-knife medical standardization and standardized operation.