肌骨超声在创伤性浅表软组织损伤中的应用
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摘要
目的探讨肌骨超声诊断创伤性浅表软组织损伤的应用价值,为肌骨超声的临床应用提供理论依据。方法选择青海省中医院自2014年1月到2016年12月期间就诊的158例创伤性浅表软组织损伤患者为研究对象,分析所纳入患者创伤性浅表软组织损伤类型的构成情况。以手术结果为金标准,分析肌骨超声诊断软组织撕裂的敏感度、特异度和诊断符合率;比较肌骨超声和MRI诊断创伤性浅表软组织损伤的符合率。结果腱鞘囊肿最为常见,有45例,占28.48%,其次为浅表性滑囊炎,有30例,占18.99%。以手术结果为金标准,肌骨超声诊断浅表软组织撕裂的敏感度为68.89%,特异度为78.57%,诊断符合率为71.19%。肌骨超声和MRI诊断韧带损伤、肌腱损伤以及肌肉损伤与手术的符合率均达75%以上,其中超声诊断符合率分别为83.33%、75.00%、75.00%,MRI诊断符合率分别为88.89%、75.00%、75.00%,两者比较,韧带损伤符合率的差异均无统计学意义(均P>0.05);超声诊断半月板损伤的符合率为42.86%,显著低于MRI诊断半月板损伤的符合率(85.71%),差异有统计学意义(P<0.05)。结论肌骨超声诊断创伤性浅表软组织损伤有较高的准确性,具有无创、可重复性强、可动态比较等优势,可作为创伤性浅表软组织损伤的常规检查措施。
Objective To investigate the application value of musculoskeletal ultrasoun in the diagnosis of traumatic superficial soft tissue injury. Methods A total of 158 patients with superficial soft tissue injury, who admitted to Department of Function of Qinghai Provincial Hospital of Traditional Chinese Medicine from January 2014 to December 2016, were selected as the subjects to analyze the composition of traumatic superficial soft tissue injury in the patients. The sensitivity, specificity and diagnostic accordance rate of ultrasound diagnosis of soft tissue laceration were analyzed with the results of surgery as the gold standard, and the coincidence rate of the diagnosis of superficial soft tissue injury was compared with that of bone marrow and MRI. Results Ganglion cysts were the most common(45 cases,28.48%), followed by superficial bursitis in 30 cases(18.99%). Taking the operation results as the gold standard, the sensitivity, specificity, diagnostic coincidence rate of musculoskeletal ultrasound in the diagnosis of superficial soft tissue tearing were respectively 68.89%, 78.57%, 71.19%. The coincidence rates of musculoskeletal ultrasound and MRI diagnosis of ligament, tendon and muscle injury and surgery coincidence rate were above 75%; the coincidence rates of ultrasonography were 83.33%, 75.00% and 75.00% respectively; the coincidence rates of MRI were 88.89%, 75.00% and75.00% respectively; there was no significant difference in the coincidence rate of ligament injury in the two groups(P>0.05). The coincidence rate of ultrasound diagnosis of meniscus injury was 42.86%, which was significantly lower than85.71% of MRI(P<0.05). Conclusion Musculoskeletal ultrasound has the high accuracy in the diagnosis of traumatic superficial soft tissue injury, which also has advantages of noninvasive, repeatability and dynamic comparison. It can be used as a routine measure for traumatic superficial soft tissue injury.
Objective To investigate the application value of musculoskeletal ultrasoun in the diagnosis of traumatic superficial soft tissue injury. Methods A total of 158 patients with superficial soft tissue injury, who admitted to Department of Function of Qinghai Provincial Hospital of Traditional Chinese Medicine from January 2014 to December 2016, were selected as the subjects to analyze the composition of traumatic superficial soft tissue injury in the patients. The sensitivity, specificity and diagnostic accordance rate of ultrasound diagnosis of soft tissue laceration were analyzed with the results of surgery as the gold standard, and the coincidence rate of the diagnosis of superficial soft tissue injury was compared with that of bone marrow and MRI. Results Ganglion cysts were the most common(45 cases,28.48%), followed by superficial bursitis in 30 cases(18.99%). Taking the operation results as the gold standard, the sensitivity, specificity, diagnostic coincidence rate of musculoskeletal ultrasound in the diagnosis of superficial soft tissue tearing were respectively 68.89%, 78.57%, 71.19%. The coincidence rates of musculoskeletal ultrasound and MRI diagnosis of ligament, tendon and muscle injury and surgery coincidence rate were above 75%; the coincidence rates of ultrasonography were 83.33%, 75.00% and 75.00% respectively; the coincidence rates of MRI were 88.89%, 75.00% and75.00% respectively; there was no significant difference in the coincidence rate of ligament injury in the two groups(P>0.05). The coincidence rate of ultrasound diagnosis of meniscus injury was 42.86%, which was significantly lower than85.71% of MRI(P<0.05). Conclusion Musculoskeletal ultrasound has the high accuracy in the diagnosis of traumatic superficial soft tissue injury, which also has advantages of noninvasive, repeatability and dynamic comparison. It can be used as a routine measure for traumatic superficial soft tissue injury.
引文
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[2]布阿依夏木·艾比,宋鹏远,玛依努尔·买买提明,等.高频超声在创伤性软组织病变诊断中的应用[J].山西医科大学学报,2015,46(12):1247-1251.
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[12]陈平.高频超声在软组织异物中的诊断价值[J].赤峰学院学报(自然科学版),2014,30(6):145-146.
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[14]袁菁菁,王怡,王涌.高频超声在腕管综合征中的应用[J].中国医学计算机成像杂志,2014,20(3):271-274.
[15]刘华.高频超声诊断肌肉损伤的临床应用价值分析[J].当代医学,2016,22(28):44-45.
[16]De Zordo T,Lill SR,Fink C,et al.Real-time sonoelastography of lateral epicondylitis:comparison of findings between patients and healthy volunteers[J].AJR Am J Roentgenol,2016,193(1):180-185.
[17]张广英,郑雷,史浩,等.高频超声与磁共振对急性外伤性髌骨外侧脱位后内侧髌股韧带损伤的对比研究[J].中华超声影像学杂志,2012,21(12):1060-1063.
[18]Behairy NH,Dorgham MA,Khaled SA.Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee:comparison with arthroscopy[J].Int Orthop,2009,33(4):961-967.
[19]张辉,方占军,潘国栋,等.超声在四肢肌肉、肌腱损伤中的诊断价值[J].河北医药,2012,34(5):738-739.
[20]Rees JD,Pilcher J,Heron C,et al.A comparison of clinical vs ultrasound determined synovitis in rheumatoid arthritis utilizing grayscale,power Doppler and the intravenous microbubble contrast agent“Sono-Vue”[J].Rheumatology(Oxford),2007,46(3):454-459.
[2]布阿依夏木·艾比,宋鹏远,玛依努尔·买买提明,等.高频超声在创伤性软组织病变诊断中的应用[J].山西医科大学学报,2015,46(12):1247-1251.
[3]穆小苏,陈松华,吴媛媛,等.高频超声与磁共振检查对浅表软组织肿块的诊断价值[J].临床军医杂志,2012,40(5):1050-1053.
[4]Wakefield RJ,Gibbon WW,Conaghan PG,et al.The value of sonography in the detection of bone erosionsin,patients with rheumatoid arthritis:a comparison with conventional radiography[J].Arthritis Rheum,2016,43(12):2762-2770.
[5]Schmidt WA,V?lker L,Zacher J,et al.Colour Doppler ultrasonography to detect pannus in knee joint synovitis[J].Clin Exp Rheumatol,2000,18(4):439-444.
[6]张英娟,刘健,刘晓玲,等.类风湿性关节炎:膝关节高频超声及超声造影表现与实验室检查的相关性[J].中国医学影像技术,2012,28(5):986-989.
[7]叶兴伟,陈旭,杨琳琳,等.彩色多普勒超声对中老年膝骨关节炎的诊断价值[J].临床超声医学杂志,2016,18(3):173-176.
[8]魏爽,吕江红,廖志平,等.肌骨超声在偏瘫肩痛软组织损伤诊疗中的应用研究进展[J].中国康复医学杂志,2016,31(4):482-484.
[9]Costa DN,Cavalcanti CF,Sernik RA.Sonographic and CT findings in lipohemarthrosis[J].AJR Am J Roentgenol,2007,188(4):W389.
[10]Szkudlarek M,Court-Payen M,Strandberg C,et al.Contrast-enhanced power Doppler ultrasonography of the metacarpophalangealjoints in rheumatoid arthritis[J].Eur Radiol,2003,13(1):163-168.
[11]麻虎,李兴勇,宋敏.膝关节半月板损伤的诊治进展[J].中医正骨,2013,25(9):31-33.
[12]陈平.高频超声在软组织异物中的诊断价值[J].赤峰学院学报(自然科学版),2014,30(6):145-146.
[13]Martín-Hervás C,Romero J,Navas-Acién A,et al.Ultrasonographic and magnetic resonance images of rotator cuff lesions compared with arthroscopy or open surgery findings[J].J Shoulder Elbow Surg,2011,10(5):410-415.
[14]袁菁菁,王怡,王涌.高频超声在腕管综合征中的应用[J].中国医学计算机成像杂志,2014,20(3):271-274.
[15]刘华.高频超声诊断肌肉损伤的临床应用价值分析[J].当代医学,2016,22(28):44-45.
[16]De Zordo T,Lill SR,Fink C,et al.Real-time sonoelastography of lateral epicondylitis:comparison of findings between patients and healthy volunteers[J].AJR Am J Roentgenol,2016,193(1):180-185.
[17]张广英,郑雷,史浩,等.高频超声与磁共振对急性外伤性髌骨外侧脱位后内侧髌股韧带损伤的对比研究[J].中华超声影像学杂志,2012,21(12):1060-1063.
[18]Behairy NH,Dorgham MA,Khaled SA.Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee:comparison with arthroscopy[J].Int Orthop,2009,33(4):961-967.
[19]张辉,方占军,潘国栋,等.超声在四肢肌肉、肌腱损伤中的诊断价值[J].河北医药,2012,34(5):738-739.
[20]Rees JD,Pilcher J,Heron C,et al.A comparison of clinical vs ultrasound determined synovitis in rheumatoid arthritis utilizing grayscale,power Doppler and the intravenous microbubble contrast agent“Sono-Vue”[J].Rheumatology(Oxford),2007,46(3):454-459.