应用剪切波弹性成像对骨骼肌早期受损评价的初步研究

Preliminary study to evaluate early musculoskeletal injury by using shear wave elastography

目的探讨剪切波弹性成像对骨骼肌早期受损评价的可行性。方法选取2020年5月至2021年1月福建中医药大学附属人民医院骨科就诊的单侧膝骨关节炎患者60例为研究对象。对患侧和健侧的膝关节进行常规扫查和剪切波弹性成像技术探查,测量内容包括软骨形态厚度及破坏程度、关节腔积液、关节滑膜厚度、韧带形态、半月板外凸程度及探测髌骨上股四头肌肌腱附着区剪切波值。比较患者患侧与健侧不同观察区肌腱厚度及剪切波值。对患者患侧膝关节按照超声特征进行赋值,采用Spearman分析超声评分与剪切波值的相关性。结果60例患者中,膝关节软骨损伤56例(56/60,93.3%),膝关节内滑膜增生30例(30/60,50.0%),膝关节内侧半月板外突35例(35/60,53.3%),膝关节腔积液57例(57/60,95.0%),膝关节骨赘形成21例(21/60,35%),膝关节腘窝囊肿0例。超声评分≤3分34例,>3~<7分26例,≥7分0例。患者患侧外侧区肌腱剪切波值显著大于患侧内侧区(P<0.01);患者健侧内侧区肌腱剪切波值显著大于患侧内侧区(P<0.01)。股四头肌肌腱剪切波值随超声评分值增高而减小,呈高度相关(r=0.955,P<0.01)。结论剪切波弹性成像是一种无创的、比较容易操作的评估肌肉损伤的手段,与膝骨关节炎程度有高度相关性,有助于发现早期劳损点,为分级诊断膝骨关节炎提供可能性。

Objective To evaluate feasibility of early skeletal muscle injury by using shear wave elastography.Methods Sixty patients with unilateral knee osteoarthritis treated in Department of Orthopedics of People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine from May 2020 to January 2021 were selected as the research subjects.Conventional scanning and shear wave elastography techniques were applied to investigate affected and healthy knees.Measurement included cartilage morphology,thickness and damage,joint cavity effusion,synovial membrane thickness,ligament morphology,meniscus protrusion degree,and detection of shear wave values in attachment area of quadriceps tendon on patella.Thickness and shear wave values of tendons in different observation areas on affected side and healthy side were compared.Affected knee joint was assigned a value based on the ultrasound characteristics,and Spearman correlation was used to analyze correlation between ultrasound score and shear wave value.Results Among 60 patients,fifty-six cases(56/60,93.3%)of cartilage injury in knee joint,30 cases(30/60,50.0%)of synovial hyperplasia in knee joint,35 cases(35/60,53.3%)of medial meniscus extrusion in knee joint,57 cases(57/60,95.0%)of effusion in knee joint cavity,21 cases(21/60,35%)of osteophyte formation in knee joint,and zero case of popliteal cyst in knee joint.There were 34 cases with ultrasound score less than three points,26 cases with score three to seven points,and zero case with score more than seven points.Shear wave value of the tendon in affected lateral area was significantly greater than that in affected medial area(P<0.01).Shear wave value of tendon in healthy medial area was significantly higher than that in affected medial area(P<0.01).Shear wave value of quadriceps tendon decreases with increase of ultrasound score,showed a high correlation(r=0.955,P<0.01).Conclusion Shear wave elastography is a non-invasive and relatively easy-to-operate method for evaluating muscle injury,which is highly correlated with severity of knee osteoarthritis,can help detect early strain points,providing possibilities for grading and diagnosis of knee osteoarthritis.