剪切波弹性成像技术用于评价排球运动员髌腱弹性恢复情况的研究

关键词：冲击波治疗  跳跃膝  实时剪切波弹性成像技术  杨氏模量

Keywords:shock wave therapy  jumper's knee  shear wave elastography  Young's modulus

摘要：

      摘要 目的：以二维超声指标低回声区面积作为评价标准，将实时剪切波弹性成像（SWE）的弹性指标杨氏模量与低回声区面积对比，评价髌腱末端病治疗前后髌腱的弹性恢复情况，同时分析杨氏模量是否可以作为评价髌腱末端病治疗效果的指标。 方法：以髌尖部存在低回声区为标准筛选了16例患有髌腱末端病的男性排球二级运动员，随机分为治疗组和对照组各8例。治疗组进行1次/周，共5周的冲击波治疗，对照组不做任何治疗；在实验前、中、后分别进行剪切波弹性成像检查和二维超声检查。采用混合设计双因素方差分析比较两组之间以及治疗前、中、后的低回声区面积和杨氏模量；采用线性回归分析低回声区面积和杨氏模量的关系。 结果：前三周、后两周以及整个治疗前后，治疗组低回声区面积均显著减小（P=0.003，P<0.001，P=0.002）；治疗组杨氏模量在前三周以及整个治疗前后均显著增大（P<0.001，P<0.001），但在最后两周治疗之间没有显著变化。对照组的低回声区面积和杨氏模量在整个过程中均无显著改变。在治疗组与对照组之间，治疗前低回声区面积和杨氏模量均没有显著差异，治疗3周和5周后治疗组低回声区面积显著小于对照组（P=0.042，P=0.003），杨氏模量显著大于对照组（P<0.001，P<0.001）。杨氏模量和低回声区面积显著负相关，当杨氏模量<80kPa时，低回声区面积=1.649-0.019×杨氏模量（R2=0.608，P<0.001）；当杨氏模量>80kPa时，低回声区面积=0.651-0.003×杨氏模量（R2=0.752，P<0.001）。 结论：在髌腱末端病恢复进程中，髌腱弹性是逐渐增大的；实时剪切波弹性成像技术可以用于评价髌腱末端病的治疗效果，髌腱杨氏模量与低回声区面积间的关系与杨氏模量大小有关。

Abstract:

      Abstract Objective： By using Hypoechoic area from two-dimensional ultrasound examination as the standard and reference and comparing Young's modulus from real-time shear wave elastography(SWE) with hypoechoic area, the aim of this study was to evaluate the elastic recovery of symptomatic patellar tendon before and after treatment and figure out whether Young's modulus could be used as an index to evaluate the treatment of jumper's knee. Method： Sixteen professional volleyball athletes with jumper’s knee were recruited and randomly divided into treatment group and control group， with 8 cases in each group. The treatment group received shock wave therapy once a week for 5 weeks，and the control group did not receive any treatment. Shear wave 1 elastography and two-dimensional ultrasound examination were performed before， during， and after therapy. Two-way analysis of variance (ANOVA) with mixed design was performed to compare hypoechoic area and Young's modulus between the two groups and before，during and after therapy. Linear regression analysis was performed to determine the relationship between hypoechoic area and Young's modulus. Result： In the first three weeks， the last two weeks， and the entire treatment， the hypoechoic area in the treatment group decreased significantly (P=0.003， P<0.001， P=0.002). The Young's modulus of the treatment group was significantly increased both in the first three weeks and the entire treatment (P<0.001， P<0.001)， while no significant change bin the last two weeks. The hypoechoic area and Young's modulus of the control group did not change during the whole process. There was no significant difference in hypoechoic area and Young's modulus between the treatment group and the control group before treatment. The hypoechoic area in the treatment group was significantly smaller than that in the control group after three and five weeks (P=0.042， P=0.003). The Young's modulus was significantly greater than that in the control group (P<0.001， P<0.001). Young's modulus exhibited a significantly negative correlation with hypoechoic area. When Young's modulus was less than 80kPa， the hypoechoic area was about 1.649-0.019 ×Young's modulus (R2=0.608， P<0.001). when Young's modulus was greater than 80kPa， the hypoechoic area was about 0.651-0.003×Young's modulus (R2=0.752， P<0.001). Conclusion： During the recovery of jumper’s knee， the elasticity of patellar tendon increases gradually. Real-time shear wave elastography can be used to evaluate the treatment effect of jumper’s knee. The relationship between Young's modulus and hypoechoic area is related to the value of the Young's modulus.