运动所致肌肉损伤的超声诊断价值
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摘要
目的探讨应用超声检查对运动引发的肌肉组织损伤诊断的效果及其超声影像学诊断特点。方法 2015年2月—2017年2月共纳入绍兴市人民医院就诊的112例疑似运动导致肌肉损伤的患者作为研究对象。患者均经超声诊断,结合病史、临床表现,必要时经局部组织的穿刺活组织检查,得出最终诊断结论。以临床最终诊断结果作为标准,考察经超声检查对肌肉损伤的检出阳性率,探讨经超声下肌肉损伤的影像学特征。结果临床最终确诊112例均为下肢肌肉损伤、无肌腱损伤和肌膜的损伤,其中腓肠肌损伤87例,跖肌损伤25例。超声诊断的准确率为91.96%,误诊率为8.04%。超声诊断单纯肌肉挫伤、单纯肌间血肿、肌肉部分断裂合并血肿、肌肉完全断裂合并血肿的准确率分别为91.11%(41/45),92.68%(38/41),93.33%(14/15),90.90%(10/11)。肌肉损伤的超声影像学特征包括:单纯肌肉挫伤主要为肌肉肿胀、厚度增加,模糊羽状样增强的回声。肌肉部分断裂合并血肿主要为肌肉部分断裂,周围可见无回声血肿区。肌肉完全断裂合并血肿主要为肌肉连续性被破坏、可见离断现象,周围可见无回声血肿区。结论超声诊断运动所致肌肉损伤的准确性较高,其具有操作便捷,快速得出结果、且有可重复性,可作为临床初诊运动性肌肉损伤的首选检查手段。
Objective To investigate the value of ultrasonography in the diagnosis of exercise-induced muscle injury and summary characteristics of ultrasound image for the diagnosis of muscle injury caused by exercise. Methods From February 2015 to February 2017, 112 cases of suspected exercise-induced muscle injury patients in our hospital were selected as the research objects. The ultrasonography was performed in all patients, and the final diagnosis was also combined with medical history, clinical manifestations, and biopsy by local tissue biopsy if necessary. With the final diagnosis as the standard, the accuracy rate of muscle injury detected by ultrasound was investigated, and the imaging features of muscle injury under ultrasound were discussed. Results A total of 112 cases were diagnosed as lower extremity muscle injury without tendon injury and myometrial injury, including 87 cases of gastrocnemius injury and 25 cases of extensor injury. The accuracy of ultrasound diagnosis was 91.96%, and the misdiagnosis rate was 8.04%. The diagnostic accuracy of ultrasound for simple muscle contusion, simple intramuscular hematoma, partial muscle rupture with hematoma and complete muscle rupture with hematoma were 91.11%(41/45), 92.68%(38/41), 93.33%(14/15) and 90.90%(10/11), respectively. Ultrasound imaging features of muscle injury include: for simple muscle contusion, there was mainly muscle swelling, increased thickness, and blurred pinnate enhanced echo; for muscle partial rupture combined with hematoma, there was mainly muscle partial rupture, and no echo hematoma around it; for the complete muscle rupture and hematoma, there were muscle continuity destruction, disruption and anechoic hematoma. Conclusion Ultrasound diagnosis of muscular injury caused by exercise has high accuracy. It is easy to operate, quickly to get results, and repeatable. It can be used as the first choice for clinical diagnosis of muscular injury caused by exercise.
Objective To investigate the value of ultrasonography in the diagnosis of exercise-induced muscle injury and summary characteristics of ultrasound image for the diagnosis of muscle injury caused by exercise. Methods From February 2015 to February 2017, 112 cases of suspected exercise-induced muscle injury patients in our hospital were selected as the research objects. The ultrasonography was performed in all patients, and the final diagnosis was also combined with medical history, clinical manifestations, and biopsy by local tissue biopsy if necessary. With the final diagnosis as the standard, the accuracy rate of muscle injury detected by ultrasound was investigated, and the imaging features of muscle injury under ultrasound were discussed. Results A total of 112 cases were diagnosed as lower extremity muscle injury without tendon injury and myometrial injury, including 87 cases of gastrocnemius injury and 25 cases of extensor injury. The accuracy of ultrasound diagnosis was 91.96%, and the misdiagnosis rate was 8.04%. The diagnostic accuracy of ultrasound for simple muscle contusion, simple intramuscular hematoma, partial muscle rupture with hematoma and complete muscle rupture with hematoma were 91.11%(41/45), 92.68%(38/41), 93.33%(14/15) and 90.90%(10/11), respectively. Ultrasound imaging features of muscle injury include: for simple muscle contusion, there was mainly muscle swelling, increased thickness, and blurred pinnate enhanced echo; for muscle partial rupture combined with hematoma, there was mainly muscle partial rupture, and no echo hematoma around it; for the complete muscle rupture and hematoma, there were muscle continuity destruction, disruption and anechoic hematoma. Conclusion Ultrasound diagnosis of muscular injury caused by exercise has high accuracy. It is easy to operate, quickly to get results, and repeatable. It can be used as the first choice for clinical diagnosis of muscular injury caused by exercise.
引文
[1] 郭艳华.高频彩色超声在肌肉损伤中的诊断效果研究[J].医疗卫生装备,2016,37(3):78-80.
[2] 邓亚娟,冉艮龙,叶伦,等.大腿肌肉损伤的MRI诊断[J].西南国防医药,2015,25(11):1222-1224.
[3] 张爱娜,孙田荣,宫丽丽.高频超声在四肢肌肉肌腱急性闭合性损伤中的诊断价值[J].青岛医药卫生,2016,48(4):288-289.
[4] PEREIRA G M V,REIS Z S N,RODRIGUES B D E S,et al.Association between pelvic floor dysfunction,and clinical and ultrasonographic evaluation in primiparous women:a cross-sectional study[J].Arch Gynecol Obstet,2018,298(2):345-352.
[5] 李星云,张金堂,谭燕,等.43例早期乳腺癌的超声诊断分析[J].中华全科医学,2015,13(12):2077-2078.
[6] 丁华杰,刘会玲,那磊,等.超声与CT/MRI对软组织肿瘤的诊断价值[J].河北医学,2016,22(10):1681-1683.
[7] PRADO-COSTA R,REBELO J,MONTEIRO-BARROSO J,et al.Ultrasound elastography:compression elastography and shear-wave elastography in the assessment of tendon injury[J].Insights Imaging,2018,9 (5):791-814.
[8] 孙建浩,来永飞,诸纪明.彩色多普勒超声在诊断老年2型糖尿病下肢血管病变中的应用[J].中华全科医学,2016,14(1):116-118.
[9] 席晓萍,马艳,张怡靓,等.高频超声在颈部肌肉骨骼大运动后损伤治疗中的应用[J].中国医疗设备,2014,29(1):154-156.
[10] 李丽,惠中义.高频彩色多普勒超声在肌肉损伤中的应用价值[J].甘肃医药,2015,34(6):448-450.
[11] 方荣军,卢长庆,史月秋,等.软组织血管平滑肌瘤的超声诊断价值[J].医学信息,2014,11(4):391.
[12] 郭永恒.超声在小腿肌肉、肌腱损伤诊断中的应用观察[J].中外医学研究,2017,15(16):31-32.
[13] 孙景芝,胡军利,侯蕾.介入性超声诊断四肢肌肉骨关节疾病的临床分析[J].医学影像学杂志,2014,13(10):1862-1863.
[14] 熊霞,叶海燕,宋明月.超声诊断四肢肌肉疾病的应用及价值评估[J].现代诊断与治疗,2017,28(15):70-72.
[15] 俞成杰,高东雯,瞿岳,等.高频超声在大运动后颈部肌肉骨骼损伤诊断治疗中的临床应用[J].现代生物医学进展,2016,16(27):5296-5299.
[16] 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.
[17] 刘慧,郭徐林,杨敏,张恒.超声弹性成像组织弥散定量分析对军训肌肉损伤的诊断价值[J].华南国防医学杂志,2016,30(4):266-268,271.
[2] 邓亚娟,冉艮龙,叶伦,等.大腿肌肉损伤的MRI诊断[J].西南国防医药,2015,25(11):1222-1224.
[3] 张爱娜,孙田荣,宫丽丽.高频超声在四肢肌肉肌腱急性闭合性损伤中的诊断价值[J].青岛医药卫生,2016,48(4):288-289.
[4] PEREIRA G M V,REIS Z S N,RODRIGUES B D E S,et al.Association between pelvic floor dysfunction,and clinical and ultrasonographic evaluation in primiparous women:a cross-sectional study[J].Arch Gynecol Obstet,2018,298(2):345-352.
[5] 李星云,张金堂,谭燕,等.43例早期乳腺癌的超声诊断分析[J].中华全科医学,2015,13(12):2077-2078.
[6] 丁华杰,刘会玲,那磊,等.超声与CT/MRI对软组织肿瘤的诊断价值[J].河北医学,2016,22(10):1681-1683.
[7] PRADO-COSTA R,REBELO J,MONTEIRO-BARROSO J,et al.Ultrasound elastography:compression elastography and shear-wave elastography in the assessment of tendon injury[J].Insights Imaging,2018,9 (5):791-814.
[8] 孙建浩,来永飞,诸纪明.彩色多普勒超声在诊断老年2型糖尿病下肢血管病变中的应用[J].中华全科医学,2016,14(1):116-118.
[9] 席晓萍,马艳,张怡靓,等.高频超声在颈部肌肉骨骼大运动后损伤治疗中的应用[J].中国医疗设备,2014,29(1):154-156.
[10] 李丽,惠中义.高频彩色多普勒超声在肌肉损伤中的应用价值[J].甘肃医药,2015,34(6):448-450.
[11] 方荣军,卢长庆,史月秋,等.软组织血管平滑肌瘤的超声诊断价值[J].医学信息,2014,11(4):391.
[12] 郭永恒.超声在小腿肌肉、肌腱损伤诊断中的应用观察[J].中外医学研究,2017,15(16):31-32.
[13] 孙景芝,胡军利,侯蕾.介入性超声诊断四肢肌肉骨关节疾病的临床分析[J].医学影像学杂志,2014,13(10):1862-1863.
[14] 熊霞,叶海燕,宋明月.超声诊断四肢肌肉疾病的应用及价值评估[J].现代诊断与治疗,2017,28(15):70-72.
[15] 俞成杰,高东雯,瞿岳,等.高频超声在大运动后颈部肌肉骨骼损伤诊断治疗中的临床应用[J].现代生物医学进展,2016,16(27):5296-5299.
[16] 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.
[17] 刘慧,郭徐林,杨敏,张恒.超声弹性成像组织弥散定量分析对军训肌肉损伤的诊断价值[J].华南国防医学杂志,2016,30(4):266-268,271.