自体半腱肌腱-股薄肌腱重建前交叉韧带术后再生肌腱的动态超声研究

Dynamic ultrasound evaluation of regeneration of semitendinosus and gracilis tendon after graft harvest for anterior cruciate ligament reconstruction

目的运用剪切波弹性成像(SWE)技术结合高频超声研究自体肌腱前交叉韧带重建术后半腱肌腱及股薄肌腱的再生状态及生物力学性能恢复。方法采用前瞻性研究方法,选取2020年1月至2022年6月于广西壮族自治区人民医院行自体肌腱前交叉韧带重建术患者25例,分别在术前及术后1个月、3个月、6个月、12个月、24个月对术前移植肌腱及术后再生肌腱行高频超声检查、剪切波弹性测量及膝关节屈曲肌力评估,记录各时间点肌腱形态、长度、面积、剪切波弹性值及肌力等级。采用重复测量方差分析比较不同时间点再生肌腱面积、剪切波弹性值。采用Spearman相关分析探讨再生肌腱剪切波弹性与膝关节屈曲肌力的相关性。结果术后半腱肌腱、股薄肌腱再生率分别为88%、92%;再生半腱肌腱、股薄肌腱长度较术前缩短(均P<0.05)。重复测量方差分析结果显示,再生肌腱面积在时间效应、组间效应差异有统计学意义(F=27.264、28.980,均P<0.001),交互效应差异无统计学意义(F=0.670,P=0.652),再生肌腱面积于术后3个月最大(P<0.05),术后12个月、24个月再生肌腱面积基本恢复至术前水平(均P>0.05)。再生肌腱剪切波弹性值在时间效应、组间效应及交互效应差异有统计学意义(F=265.402、33.015、11.475,均P<0.001),术后再生肌腱剪切波弹性值随时间增加逐渐升高。术后膝关节屈曲肌力等级随时间增加而升高(χ^(2)=34.83,P<0.001),术后再生半腱肌腱、股薄肌腱剪切波弹性值与肌力等级间呈显著正相关(rs=0.755、0.761,均P<0.001)。结论高频超声显示自体肌腱移植术后半腱、股薄肌腱大部分可再生,膝关节屈曲肌力及再生肌腱剪切波弹性值随时间推移逐渐恢复,提示SWE可为预测再生肌腱生物力学性能恢复提供影像学参考。

Objective To evaluate the regeneration and biomechanical property recovery of semitendinosus tendon(ST)/gracilis tendon(GT)after anterior cruciate ligament(ACL)reconstruction using shear wave elastorgraphy(SWE)combined with high-frequency ultrasound(HFUS).Methods Twenty-five patients who underwent ST/GT autograft reconstruction after ACL rupture at the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2020 to June 2022 were prospectively enrolled.All patients underwent HFUS,SWE and flexion strength assessment at pre-operation and 1,3,6,12,24 months postoperatively.The morphology,length,cross-sectional area and SWE of ST/GT and flexion strength of knee were recorded at each time point.Repeated measures analysis of variance was employed to compare the cross-sectional area and elasticity value of regenerated ST/GT at different time points.Spearman correlation analysis was used to investigate the relationship between the elasticity value of regenerated ST/GT and flexion strength.Results The regeneration rates of ST/GT after being harvested for ACL reconstruction were 88%and 92%.The length of the regenerated ST/GT were shorter than before operation(both P<0.05).Repeated measures analysis of variance revealed significant differences in the cross-sectional area of regenerated ST/GT,both in terms of time effect and inter-group effect(F=27.264,28.980;both P<0.001),but no significant difference was observed in the interaction effect(F=0.670,P=0.652).The cross-sectional area of regenerated ST/GT was the largest at 3 months postoperatively(P<0.05),and restored to the preoperative level at 12 and 24 months postoperatively(both P>0.05).Repeated measures analysis of variance showed that the elasticity values of the regenerated ST/GT were significantly different in terms of time effect,group effect,and interaction effect(F=265.402,33.015,11.475;all P<0.001).The elasticity of regenerated ST/GT post-operation gradually increased over time.The flexion strength level of knee gradually improved post-operation(χ^(2)=34.83,P<0.001).The elasticity values of the regenerated ST and GT showed significant positive correlations with the flexion strength(r s=0.755,0.761;both P<0.001).Conclusions HFUS discovers that most of ST/GT can be regenerated after being harvested for ACL reconstruction.The flexion strength and elasticity value of regenerated tendon recover gradually with time.It is suggested that the SWE can predict the recovery of biomechanical property of regenerated ST/GT.