剪切波弹性超声成像测量股四头肌及肌腱弹性与膝骨关节炎功能的相关性  

Functional correlation between the elasticity of the quadriceps and its tendons and osteoarthritis of the knee based on shear wave elastography measurements

作　　者：黄钰颖 郭忆[3] 韩新祚[4] 闵红巍[1,4] 李雪梅[3] 刘克敏[1,4] Huang Yuying;Guo Yi;Han Xinzuo;Min Hongwei;Li Xuemei;Liu Kemin(School of Rehabilitation Medicine,Capital Medical University,Beijing 100068,China;First Department of Neurorehabilitation,Zhejiang Rehabilitation Medical Center,Hangzhou 310052,Zhejiang Province,China;Department of Ultrasound,Beijing Boai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Department of Bone and Joint Rehabilitation,Beijing Boai Hospital,China Rehabilitation Research Center,Beijing 100068,China)

机构地区：[1]首都医科大学康复医学院,北京市100068 [2]浙江康复医疗中心神经康复一科,浙江省杭州市310052 [3]中国康复研究中心北京博爱医院超声科,北京市100068 [4]中国康复研究中心北京博爱医院骨与关节康复科,北京市100068

出　　处：《中国组织工程研究》2023年第31期4971-4976,共6页Chinese Journal of Tissue Engineering Research

基　　金：丰台区卫生健康系统科研项目(2019-112),项目负责人:闵红巍;中国康复研究中心科研项目(2020-04),项目负责人:刘克敏。

摘　　要：背景:已有研究表明膝骨关节炎患者肌肉弹性会发生变化,但目前的研究多关注于肌张力、肌肉力量的评估,对于股四头肌及其肌腱弹性的评估却鲜有报道。目的:探究膝骨关节炎患者股四头肌及其肌腱弹性模量特征,并分析其与膝关节疼痛、功能的关系,为膝骨关节炎的防治提供一定依据。方法:采用剪切波弹性超声成像技术测量30例临床确诊为膝骨关节炎的患者(膝骨关节炎组)和28名无膝关节疼痛的志愿者(对照组)股四头肌及其肌腱的弹性模量。使用西安大略和麦克马斯特大学骨关节炎指数量表(WOMAC)评估入组患者膝关节的疼痛和功能。比较两组受试者股四头肌弹性模量的变化,统计学分析股四头肌弹性模量与WOMAC评分的相关性。结果与结论:①膝骨关节炎组的股直肌、股中间肌、股内侧肌、股外侧肌、股四头肌肌腱的厚度均小于对照组,但仅膝骨关节炎组的股外侧肌弹性模量值明显大于对照组,差异均有显著性意义(P<0.05)。②选取与对照组有特征性差异的肌肉弹性模量进行相关性分析,膝骨关节炎组的股外侧肌弹性模量值与WOMAC疼痛量表呈低度线性相关(r=0.367,P<0.05)。在自我报告的疼痛中,膝骨关节炎患者股外侧肌的弹性模量值仅与上下楼时的疼痛程度呈中度线性正相关(r=0.584,P<0.05)。在自我报告的功能障碍中,膝骨关节炎患者股外侧肌弹性模量值与下楼梯时、从座位上站起来时的功能均呈中度线性相关(r=0.411,P<0.05;r=0.464,P<0.05)。③综上,股外侧肌硬度增高是膝骨关节炎患者股四头肌的特征性改变,从而反映出膝关节负荷增加时的疼痛及功能情况,需进一步研究弹性模量对评估膝骨关节炎患者病情、疗效的意义,从而实现精准康复治疗。BACKGROUND: It has been shown that muscle elasticity changes in patients with knee osteoarthritis, but most of the current studies have focused on the assessment of muscle tone and muscle strength. Changes in the elasticity of the quadriceps and its tendons in patients with knee osteoarthritis have rarely been reported.OBJECTIVE: To investigate the characteristics of the elastic modulus of the quadriceps femoris and its tendons in patients with knee osteoarthritis and to analyze its relationship with knee pain and function, thereby providing some basis for the prevention and treatment of knee osteoarthritis.METHODS: The elasticity of the quadriceps femoris and its tendons was measured by shear wave elastography in 30 patients with clinically confirmed knee osteoarthritis(knee osteoarthritis group) and 28 healthy individuals without knee pain(control group). The Western Ontario and McMaster University Osteoarthritis Index(WOMAC) was used for knee pain and function assessments in both groups. Changes in the modulus of elasticity of the quadriceps were compared between the two groups. The correlation between the elastic modulus of the quadriceps muscle and the WOMAC score was statistically analyzed.RESULTS AND CONCLUSION:(1) The thickness of the rectus femoris, middle femoris, medial femoris, lateral femoris and quadriceps tendon was less in the knee osteoarthritis group than in the control group. The elastic modulus of the lateral femoris was significantly higher in the knee osteoarthritis group than in the control group(P < 0.05).(2) The elastic modulus of muscles that was characteristically different from the control group was selected for correlation analysis.The elastic modulus of the lateral femoris in the knee osteoarthritis group showed a low linear correlation with the WOMAC pain scale(r=0.367, P < 0.05). In the self-reported pain scale, the elastic modulus of the lateral femoris in patients with knee osteoarthritis was only moderately linearly positively correlated with pain level during going up/downstair

关 键 词：膝骨关节炎 剪切波弹性成像技术 股四头肌 弹性模量 WOMAC评分 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R49