体外冲击波作用腱骨组织后MRI信号值变化的研究

Research on the changes of MRI signal value after extracorporeal shock wave applied to tendon-bone tissue

[目的]通过对比体外冲击波作用于髌韧带腱骨组织前后MRI信号值,探讨MRI评估体外冲击波作用腱骨组织伤病疗效的敏感性及促进腱骨愈合的意义。[方法]选择10名健康成人志愿者,以右侧膝关节髌韧带与髌骨下极、胫骨结节移行区为腱骨交界观察区域,仅将体外冲击波干预因素作用于髌韧带胫骨结节移行区,另一腱骨交界区作空白对照,分别于体外冲击波干预前、干预后1 h、24 h、7 d行3.0T MRI扫描。对MRI进行阅片,于四个不同时间节点分别应用图像处理程序软件,测定MRI扫描图像压脂T_(2)WI像在矢状位和横轴位腱骨移行区设定窗口内信号值,使用SPSS 19.0统计软件对获得的数据进行对比分析。[结果]于体外冲击波干预前、干预后1 h、24 h及7 d时间节点,髌骨下极移行观察区皮下软组织和腱骨组织压脂T_(2)WI像方差分析F值分别为:矢状位0.356、1.939,横轴位0.209、0.541,均P>0.05,无统计学意义。髌韧带胫骨结节移行观察区皮下软组织和腱骨组织压脂T_(2)WI像方差分析F值分别为:矢状位2 333.355、522.171,横轴位1 772.229、482.754,均P<0.05,差异具有显著统计学意义。[结论]体外冲击波作用于肌腱骨骼移行区后可在MRI上表现出信号值变化,证实MRI可作为评估体外冲击波作用于腱骨组织伤病疗效的一种敏感而有效的影像学检查方式,同时也提示体外冲击波可造成移行区皮下软组织和腱骨组织的微损伤,损伤后反应可能是促进腱骨愈合作用的原因之一。

[Objective]To explore the sensitivity of MRI in evaluating the efficacy of extracorporeal shock wave on tendon-bone tissue injuries and its significance in evaluating extracorporeal shock wave promoting tendon-bone healing by comparing the MRI signal values before and after extracorporeal shock wave for patellar ligament tendon-bone tissue.[Methods] Ten healthy adult volunteers were selected.The right knee joint patellar ligament,patellar interior pole and tibial tuberosity transition zone,were used as the tendon-bone junction observation area.Only the extracorporeal shock wave intervention factors were applied to the patellar ligament tibial tuberosity transition zone,and the other tendon-bone junction area was used as a blank control.3.0 T MRI scans were performed before extracorporeal shock wave intervention,1 h,24 h,and 7 d after intervention.The MRI films were read,and the image processing program software was used at four different time nodes,so as to measure the signal values in the setting window of the tendon-bone transition zone of the fat-suppressed T_(2)WI image of the MRI scan image in the sagittal and transverse axial positions,and the SPSS 19.0 statistical software was used to compare and analyze the obtained data.[Results]At the time points before extracorporeal shock wave intervention,1 h,24 h and 7 d after intervention,the fat-suppressed T_(2)WI image variance F values of subcutaneous soft tissue and tendon-bone tissue in the observation zone of patellar inferior pole transition were as follows:sagittal position for 0.356 and 1.939;transverse position for 0.209 and 0.541,and the difference was not significant(all P>0.05);the variance F values of T_(2)WI images of subcutaneous soft tissue and tendon-bone tissue in the transitional observation zone of patellar ligament and tibial tuberosity were as follows:sagittal position for 2333.355 and 522.171,transverse position for 1772.229 and 482.754,and the difference was statistically significant(all P<0.05).[Conclusion]Extracorporeal shock wave can show the changes of signal value on MRI after it is applied to the tendon-bone transition zone,and it is confirmed that MRI can be used as a sensitive and effective imaging examination method to evaluate the efficacy of extracorporeal shock wave on tendon-bone tissue injuries.It also suggests that extracorporeal shock wave can cause subcutaneous soft tissue and tendon-bone tissue in the transition zone.The reaction after injury may be one of the reasons for promoting tendonbone healing.