军事训练跟腱损伤人员的高频肌骨超声灰度表现及其在诊断跟腱断裂中的价值

High-frequency musculoskeletal ultrasound gray scale features of Achilles tendon injuries in military training personnel and its value in diagnosing Achilles tendon rupture

目的探究军事训练跟腱损伤人员的高频肌骨超声灰度表现及其在跟腱断裂中的诊断价值。方法回顾性分析2019年7月—2022年7月中国人民解放军联勤保障中心第904医院接诊的参与军事训练后跟腱损伤患者106例,男性90例,女性16例;年龄18~39岁,平均25.1岁。均经手术证实为单侧跟腱损伤。分析高频肌骨超声(美国GE公司Logiq E9型)平扫检查浅表骨骼肌肉组织与手术诊断跟腱断裂的一致性,并比较手术诊断和超声诊断结果下患者的患侧和健侧高频肌骨超声灰度值差异,分析高频肌骨超声灰度值对跟腱断裂的诊断效能。结果106例跟腱损伤患者中,经手术诊断跟腱断裂86例,其中超声诊断跟腱断裂76例,未断裂10例;手术确诊跟腱未断裂20例,其中超声诊断跟腱未断裂12例,断裂8例,超声诊断跟腱损伤的特异度为88.4%(76/86),灵敏度为60.0%(12/20)。超声诊断和手术诊断跟腱断裂的Kappa值为0.465。跟腱断裂患者的患侧区高频肌骨超声灰度值(32.29±12.34)低于邻近健康区(69.81±17.45)和健侧区(71.03±20.41,P<0.05),邻近健康区和健侧区比较差异无统计学意义(P>0.05)。跟腱断裂组患侧区高频肌骨超声灰度值(32.29±12.34)低于跟腱未断裂组(54.71±16.89,P<0.05)。受试者工作特征(receiver operating characteristic,ROC)分析结果显示,高频肌骨超声灰度值诊断跟腱断裂的ROC曲线下面积为0.737(95%CI:0.592~0.882)。结论军事训练跟腱损伤人员患侧区高频肌骨超声灰度值降低,高频肌骨超声灰度值诊断跟腱断裂具有良好价值。

Objective To explore the gray scale features by high-frequency musculoskeletal ultrasound(MSKUS)of the Achilles tendon injuries(ATI)in military training personnel and to investigate its diagnostic value for Achilles tendon rupture(ATR).Methods A retrospective analysis was made on 106 patients with ATI after military training,including 90 male and 16 female aged 18-39 years,mean 25.1 years,who were admitted to No.904 Hospital of PLA Joint Logistic Support Center from Jul.2019 to Jul.2022.All cases were confirmed by surgery as unilateral ATI.The diagnosis consistency of ATR was compared between by high-frequency MSKUS(GE Logiq E9,USA)via plain scan of the superficial skeletal muscle tissue and by surgery,and the grey scale between the injury side and the health side was further compared,by both diagnosis techniques.Moreover the diagnostic efficacy of high-frequency MSKUS gray scale values for ATR was investigated.Results Among the 106 ATI patients,surgery confirmed ATR in 86 cases(76 successfully revealed by ultrasound and the rest 10 failed with the ultrasound showing no rupture)and no ATR in the other 20 cases(12 correctly shown by ultrasound as no rupture and 8 wrongly shown as rupture).The specificity and sensitivity of ultrasonic diagnosis of ATR were 88.4%(76/86)and 60.0%(12/20).Kappa value of ultrasonic diagnosis and surgical diagnosis of ATR was 0.465.For the 86 patients with ATR,the gray value of high-frequency MSKUS at the rupture area(32.29±12.34)was significantly lower than that in the adjacent healthy area(69.81±17.45)and the contralateral healthy side(71.03±20.41),P<0.05,but there was no statistical difference between the adjacent healthy area and the contralateral healthy side(P>0.05).Compared with the 20 non-rupture patients(54.71±16.89),the gray value of high-frequency MSKUS for ATR patients(32.29±12.34)was also much lower(P<0.05).ROC analysis results showed that the area under curve(AUC)of high-frequency MSKUS in diagnosing ATR was 0.737(95%CI:0.592-0.882).Conclusion The gray value of high-frequency MSKUS decreased in the injury area of soldiers with ATI following military training.The high-frequency MSKUS gray value has good diagnostic efficacy in the diagnosis of ATR.