剪切波弹性成像在辅助软组织松解术后跟腱功能评估中的应用

doi:10.3969/j.issn.1006-9771.2021.09.016

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (9): 1098-1103.doi: 10.3969/j.issn.1006-9771.2021.09.016

剪切波弹性成像在辅助软组织松解术后跟腱功能评估中的应用

单洁玲^1a,朱俞岚^1b,阮婷婷^1a,顾晟晨²,黄凯文³,李蕴^1b,朱玉连^1b()

1.复旦大学附属华山医院,a. 超声医学科；b. 康复医学科,上海市 200040
2.上海健康医学院康复学院,上海市 200237
3.上海杉达学院国际医学技术学院,上海市 201209

收稿日期:2021-05-26 修回日期:2021-07-30 出版日期:2021-09-25 发布日期:2021-10-09
通讯作者: 朱玉连 E-mail:zyljully@163.com
作者简介:单洁玲(1967-),女,汉族,上海市人,主管技师,主要研究方向：肌腱韧带运动损伤的肌骨超声康复评估。
基金资助:
上海市体育科技"备战攻关计划"项目(20J021)

Effect of Instrument-assisted Soft Tissue Mobilization on Achilles Tendon Using Shear Wave Elastography

SHAN Jie-ling^1a,ZHU Yu-lan^1b,RUAN Ting-ting^1a,GU Sheng-chen²,HUANG Kai-wen³,LI Yun^1b,ZHU Yu-lian^1b()

1. a. Department of Ultrasound Medicine; b. Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
2. School of Rehabilitation, Shanghai Health Medical College, Shanghai 200237, China
3. School of International Medical Technology, Shanghai Shanda University, Shanghai 201209, China

Received:2021-05-26 Revised:2021-07-30 Published:2021-09-25 Online:2021-10-09
Contact: ZHU Yu-lian E-mail:zyljully@163.com
Supported by:
Shanghai Sports Science and Technology Preparing Planning(20J021)

摘要/Abstract

摘要：

目的利用高频超声剪切波弹性成像评估辅助软组织松解术(IASTM)对健康成人跟腱的作用。方法 2020年7月至12月,健康成人受试者52例随机分入对照组(n = 15)和试验组(n = 37)。试验组接受左侧跟腱IASTM治疗,隔天1次,共2周;对照组不作处理。治疗前、首次治疗后即刻、治疗后3 d,采用高频超声和超声剪切波弹性成像测量受试者左侧跟腱厚度和弹性模量。结果末次治疗后,试验组5例脱失。治疗前,两组左跟腱厚度、弹性模量均无显著性差异(t < 0.63, P > 0.05)。治疗后即刻,试验组左跟腱厚度较对照组减少(t = 2.149, P < 0.05);治疗后3 d,左跟腱弹性模量平均值和最大值较对照组减少(t > 2.134, P < 0.05)。结论超声剪切波弹性成像可以量化评估IASTM对跟腱的疗效。

关键词: 剪切波弹性成像, 辅助软组织松解技术, 跟腱, 康复评定

Abstract:

Objective To apply real-time shear wave elastography to observe the effect of instrument-assisted soft tissue mobilization (IASTM) on Achilles tendons for healthy adults.Methods From July to December, 2020, 52 healthy adults were assigned into control group (n = 15) and experimental group (n = 37) randomly. The experimental group received IASTM on left Achilles tendons, once another day for two weeks, while the control group received no treatment. The thickness and elastic modulus of the left Achilles tendons were measured with high-frequency ultrasound and shear wave ultrasound elastography on all the subjects, before treatment, immediately after the first treatment and three days after treatment, respectively.Results Five cases dropped down in the experimental group. There was no significant difference in thickness and elastic Young's modulus of the left Achilles tendons between two groups before treatment (t < 0.630, P > 0.05). The thickness of the left Achilles tendons was less in the experimental group than in the control group immediately after the first treatment (t = 2.149, P < 0.05), while average and maximum elastic Young's modulus was less three days after treatment (t > 2.134, P < 0.05).Conclusion Real-time shear wave elastography could quantify the thickness and elasticity of Achilles tendon, to evaluate the effect of IASTM.

Key words: shear wave elastography, instrument-assisted soft tissue mobilization, Achilles tendon, rehabilitation assessment

单洁玲,朱俞岚,阮婷婷,顾晟晨,黄凯文,李蕴,朱玉连. 剪切波弹性成像在辅助软组织松解术后跟腱功能评估中的应用[J]. 《中国康复理论与实践》, 2021, 27(9): 1098-1103.

SHAN Jie-ling,ZHU Yu-lan,RUAN Ting-ting,GU Sheng-chen,HUANG Kai-wen,LI Yun,ZHU Yu-lian. Effect of Instrument-assisted Soft Tissue Mobilization on Achilles Tendon Using Shear Wave Elastography[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(9): 1098-1103.

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参考文献 22

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组别	n	性别(男/女, n)	年龄(岁)	体质量(kg)	身高(cm)	BMI (kg/m²)
对照组	15	8/7	23±3.0	63±8.9	171±7.1	21±1.8
试验组	37	13/24	25±3.2	62±9.8	167±8.4	22±2.4
t值			1.922	0.307	1.395	0.856
P值		0.350^a	0.060	0.760	0.169	0.396

组别	项目	治疗前	首次治疗后				末次治疗后
组别	项目	几何均数(CV%)	几何均数(CV%)	几何均数百分比 (95%CI)	F值^a	P值^a	几何均数(CV%)	几何均数百分比(95%CI)	F值^a	P值^a
对照组	厚度(cm)	0.45(12.2)	0.46(11.4)	101(98,104)	0.331	0.574	0.45(15.1)	100(96,104)	0.002	0.969
(n = 15)	弹性模量(kPa)
	最小值	13.64(70.1)	22.06(46.8)	162(74,354)	1.730	0.210	33.14(19.7)	243(86,683)	3.388	0.087
	平均值	94.81(6.3)	95.53(5.1)	101(92,110)	0.034	0.857	91.27(5.9)	96(88,105)	0.906	0.357
	最大值	166.08(5.5)	154.65(4.6)	93(83,104)	1.841	0.196	166.56(4.9)	100(92,110)	0.005	0.945
试验组	厚度(cm)	0.45(12.0)	0.44(12.9)	98(97,99)	10.100	0.003	0.44(12.5)	98(96,100)	3.709	0.063
(n = 37/32)^b	弹性模量(kPa)
	最小值	19.91(48.3)	25.67(31.6)	129(88,190)	1.778	0.191	22.95(35.3)	115(73,181)	0.409	0.527
	平均值	101.17(7.2)	95.97(7.8)	95(87,103)	1.651	0.207	82.06(4.3)	81(73,90)	16.570	< 0.001
	最大值	176.41(6.9)	173.32(7.5)	98(88,109)	0.111	0.741	140.82(6.0)	80(71,90)	13.740	< 0.001

时间		对照组 (n = 15)	试验组 (n = 37/32)^a	几何均数百分比(95%CI)	F/t值	P值
治疗前	厚度〔几何均数(CV%), cm〕	0.45(12.2)	0.45(12.0)	99(94,105 )	0.060^b	0.810
	弹性模量〔几何均数(CV%), kPa〕
	最小值	13.64(70.1)	19.91(48.3)	146(56,382)	0.630^b	0.433
	平均值	94.81(6.3)	101.17(7.2)	107(88,130)	0.440^b	0.512
	最大值	166.08(5.5)	176.41(6.9)	106(86,131)	0.340^b	0.563
首次治疗后	厚度〔最小二乘几何均数^c, cm〕	0.46	0.44	97(95,100)	2.149	0.037
	弹性模量〔最小二乘几何均数^c, kPa〕
	最小值	24.99	24.4	98(55,172)	0.084	0.933
	平均值	98.97	94.61	96(84,109)	0.674	0.503
	最大值	159.1	171.3	108(91,128)	0.879	0.384
末次治疗后	厚度〔最小二乘几何均数^c, cm〕	0.45	0.44	98(94,102)	0.936	0.355
	弹性模量〔最小二乘几何均数^c, kPa〕
	最小值	34.95	22.39	64(36,114)	1.557	0.127
	平均值	92.12	81.7	89(79,99)	2.134	0.039
	最大值	170.5	139.3	82(70,95)	2.660	0.011

剪切波弹性成像在辅助软组织松解术后跟腱功能评估中的应用

Effect of Instrument-assisted Soft Tissue Mobilization on Achilles Tendon Using Shear Wave Elastography

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