高频超声及剪切波弹性成像评估指伸肌腱断裂修复术后疗效

Evaluation of postoperative efficacy of extensor digitorum tendon rupture repair by high-frequency ultrasound and shear wave elastography

目的 探讨高频超声及剪切波弹性成像(SWE)评估单侧指伸肌腱完全断裂修复术后不同时间疗效的临床应用价值。方法 前瞻性收集于我院创伤中心就诊的33例单侧指伸肌腱断裂患者(共41根断裂指伸肌腱),均经手术修复,术后1、3、6个月应用高频超声及SWE测量指伸肌腱修复区及健侧相同肌腱同一部位厚度、血流及剪切波速度平均值、最小值、最大值(SWVmean、SWVmin、SWVmax),并记录患侧及健侧手指功能总主动活动度(TAM),比较健侧与患侧,以及患侧术后不同时间上述参数的差异;分析上述参数与TAM的相关性。结果 术后1、3个月患侧指伸肌腱厚度均较健侧增加,差异均有统计学意义(均P<0.05);术后6个月患侧指伸肌腱厚度接近健侧肌腱,差异无统计学意义。术后1、3个月患侧指伸肌腱血流信号评分与健侧比较差异均有统计学意义(均P<0.05),术后6个月患侧指伸肌腱血流信号评分与健侧比较差异无统计学意义。术后1、3、6个月患侧指伸肌腱SWVmean、SWVmin、SWVmax均小于健侧,差异均有统计学意义(均P<0.05)。术后1、3、6个月患侧指伸肌腱厚度、血流信号评分逐渐减小,SWVmean、SWVmin、SWVmax逐渐增加,两两比较差异均有统计学意义(均P<0.05)。术后1、3、6个月患侧指伸肌腱TAM均小于健侧,差异均有统计学意义(均P<0.05);术后1、3、6个月患侧指伸肌腱TAM逐渐增加,两两比较差异均有统计学意义(均P<0.05)。术后患侧指伸肌腱厚度、血流信号评分与TAM均呈负相关(r=-0.497、-0.635,均P<0.05),SWVmean、SWVmin、SWVmax与TAM均呈正相关(r=0.834、0.691、0.832,均P<0.05)。结论 高频超声及SWE在评估单侧指伸肌腱完全断裂修复术后不同时间疗效中有一定的临床应用价值。

Objective To investigate the clinical application value of high-frequency ultrasound and shear wave elastography(SWE)in evaluating the postoperative efficacy of unilateral complete extensor digitorum tendon rupture repair at different time points.Methods A prospective study was conducted involving 41 extensor digitorum tendons from 33 patients with unilateral extensor digitorum tendon rupture treated at the trauma center of our hospital.All tendons were surgically repaired,and the were used to measure tendon thickness,blood flow and mean,minimum,maximum shear wave velocity(SWVmean,SWVmin,SWVmax)at the repair site at 1,3,and 6 months postoperatively and corresponding healthy tendons by high-frequency ultrasound and SWE.The total active functional range(TAM)of the affected and healthy fingers were recorded.The differences of above parameters between the healthy and affected sides,and at different postoperative time points were compared.The correlation between above parameters and TAM were analyzed.Results At 1 and 3 months after operation,the thickness of the affected tendons was greater than that of the healthy side,with statistically significant differences(both P<0.05).At 6 months after operation,the thickness of the affected tendons was similar to the healthy tendons,with no significant difference.Compared with healthy side,the blood flow signal scores of the affected tendons were statistically significant at 1 and 3 months after operation(both P<0.05),but there was no statistically significant differences at 6 months after operation.SWVmean,SWVmin and SWVmax of the affected tendons were lower than those of the healthy side at 1,3,and 6 months after operation,with statistically significant differences(all P<0.05).Tendon thickness and blood flow signal scores of the affected side gradually decreased over time,while SWVmean,SWVmin and SWVmax increased at 1,3,and 6 months after operation,with statistically significant differences in pairwise comparison(all P<0.05).The TAM of the affected tendons was significantly lower than that of the healthy side at 1,3,and 6 months after operation(all P<0.05),but gradually increased over time,with statistically significant differences in pairwise comparison(all P<0.05).The thickness and blood flow signal scores were negatively correlated with TAM(r=-0.497,-0.635,both P<0.05),and SWVmean,SWVmin,SWVmax were positively correlated with TAM(r=0.834,0.691,0.832,all P<0.05).Conclusion High-frequency ultrasound and SWE have a certain clinical value in assessing the efficacy of unilateral complete extensor digitorum tendon rupture repair at different postoperative time points.