超声弹性成像技术评估腰部“筋”伤的可行性临床研究  

Clinical study on feasibility of assessing lumbar"tendon"injuries with ultrasound elastography

作　　者：赵璐璐 盛建国 郭小玉 韩秋成[1] 刘怡 郭佳 王翔[2,3] ZHAO Lulu;SHENG Jianguo;GUO Xiaoyu;HAN Qiucheng;LIU Yi;GUO Jia;WANG Xiang(Department of Ultrasonic Medicine,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Shi's Center of Orthopedics and Traumatology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Institute of Traumatology and Orthopedics,Shanghai Academy of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院超声医学科,上海201203 [2]上海中医药大学附属曙光医院石氏伤科,上海201203 [3]上海市中医药研究院中医骨伤科研究所,上海201203

出　　处：《上海中医药杂志》2024年第9期45-49,共5页Shanghai Journal of Traditional Chinese Medicine

基　　金：上海市科委2020年度“科技创新行动计划”医学创新研究专项项目(20MC1920600);上海市科委科技计划项目(22Y21920200);上海市卫健委临床重点专科建设项目(shslczdzk03901)。

摘　　要：目的探讨超声弹性成像技术(声辐射力脉冲成像技术)量化评估腰部“筋”伤的临床可行性。方法选取90例被诊断为单侧慢性非特异性腰痛患者(经3个月强筋功法训练后已无腰痛症状)。在训练前后,采用彩色多普勒超声诊断仪检查所有患者L4~L5节段两侧多裂肌并测量多裂肌厚度、截面积,利用声辐射力脉冲成像技术测量多裂肌剪切波速度(SWV)。结果①最终共收集90例患者,其中男性26例、女性64例,平均年龄(28.49±5.81)岁,平均体质量指数(22.20±2.45)kg·m-2。②训练前,疼痛侧与非疼痛侧多裂肌的厚度、截面积及SWV的差异均具有统计学意义(P<0.05)。训练后,疼痛侧与非疼痛侧多裂肌的厚度、截面积及SWV的差异均无统计学意义(P>0.05)。③训练后,浅层与深层多裂肌的深度及SWV比较,差异具有统计学意义(P<0.05)。④训练后,两侧多裂肌厚度的平均值、截面积的平均值和SWV的平均值之间存在相关性(r=0.311,P=0.004;r=0.316,P=0.003)。⑤训练后,两侧多裂肌SWV重复测量的组内一致性良好(P<0.05)。结论声辐射力脉冲成像技术是量化评估腰骶部“筋”形态功能的可靠手段,可用于指导和评价慢性筋骨病从“筋”论治,适合临床推广应用。Objective To explore the clinical feasibility of using ultrasound elastography(acoustic radiation force impulse imaging)to quantitatively assess lumbar"tendon"injuries.Methods Ninety subjects diagnosed with chronic non-specific low back pain,who were symptom-free after undergoing tendon-strengthening exercises,were recruited.Using a color Doppler ultrasound,the thickness and cross-sectional area of the bilateral multifidus muscles at the L4-L5 segment were measured,and the shear wave velocity(SWV)was measured using acoustic radiation force impulse(ARFI)imaging.Results①The study ultimately included 90 participants(26 males,64 females)with an average age of(28.49±5.81)years and an average BMI of(22.20±2.45)kg·m-2.②Before training,the differences in thickness,cross-sectional area and SWV of the multifidus muscle between the painful side and the contralateral side were statistically significant(P<0.05).After training,there was no statistically significant difference in the thickness,cross-sectional area,or SWV of the multifidus muscles between the painful side and the contralateral side(P>0.05).③After training,the comparison of the depth and SWV between the superficial and deep layers of the multifidus muscles showed statistically significant differences(P<0.05).④After training,there was a correlation between the average thickness,average cross-sectional area,and average SWV of the bilateral multifidus muscles(r=0.311,P=0.004;r=0.316,P=0.003).⑤After training,the intra-group consistency of repeated SWV measurements was good for both the left and right multifidus muscles(P<0.05).Conclusion ARFI imaging is a reliable method for quantitatively assessing the morphological and functional characteristics of lumbar"tendons".It is suitable for clinical application to guide and evaluate the treatment of chronic musculoskeletal conditions from a"tendon"perspective.

关 键 词：腰痛 “筋”伤 超声检查 肌骨超声 声辐射力脉冲成像 石氏伤科 中医骨伤学 

分 类 号：R274.9[医药卫生—中西医结合]