实时剪切波弹性成像技术评估踝关节外侧副韧带急性闭合型损伤的临床应用

doi:10.3877/cma.j.issn.1672-6448.2019.11.004

目的

采用通过实时剪切波弹性成像技术（SWE）技术，探讨对急性踝关节损伤患者外侧副韧带硬度评价，来实现踝关节外侧副韧带损伤的准确诊断的临床价值。

方法

选取2018年12月到至2019年6月在首都医科大学附属北京朝阳医院急诊和骨科门诊就诊的50例踝关节外侧副韧带急性损伤患者，均接受进行高频超声及SWE超声弹性检测检查，获得患侧和健侧外侧副韧带的弹性杨氏模量平均值和剪切波速度（SWV），比较不同类型并与正常侧的差异对比，以此判断闭合性外侧副韧带损伤的程度。

结果

50例踝关节外侧副韧带损伤患者中，经手术及MRI证实共损伤80条韧带，距腓前韧带损伤42例，跟腓韧带22例，距腓后韧带16例。经急诊手术结果显示证实完全断裂韧带21例，距腓前韧带11例，跟腓韧带5例，距腓后韧带5例，高频超声快速诊断均正确检出，诊断符合率为100%。经MRI诊断，不完全断裂韧带19例，距腓前韧带8例，跟腓韧带6例，距腓后韧带5例，高频超声正确诊断14例，漏诊5例，超声诊断为挫伤，诊断符合率74%。经MRI诊断韧带挫伤40例，距腓前韧带20例，跟腓韧带12例，距腓后韧带8例，超声正确诊断挫伤35例，诊断符合率为87%。5例误诊为部分韧带断裂。韧带完全断裂组、韧带部分断裂组、韧带挫伤组和正常韧带组超声弹性杨氏模量值和SWV总体，差异均有统计学意义［（41.86±14.85）kpa vs（54.95±12.48）kpa vs（86.03±28.17）kpa vs（158.29±61.98）kpa，（3.68±1.68）m/s vs（4.25±0.52）m/s vs（5.28±0.90）m/s vs（7.13±1.39）m/s，F=56.147、79.539，P均<0.001］。四组间两两比较，韧带完全断裂组与部分断裂组，差异无统计学意义，其他组两两比较，差异均有统计学意义（t=44.168、1.602；116.432、3.453；31.077、1.029；103.342、2.881；72.265、1.851；P均<0.05）。

结论

超声弹性成像可以作为对高频超声诊断踝关节外侧副韧带断裂进行的有效补充。精确诊断韧带是否存在微小断裂。

关键词: 弹性成像技术, 高频超声, 踝关节外侧副韧带, 创伤和损伤

Objective

To investigate the clinical value of real-time shear wave elastography (SWE) in the evaluation of acute lateral collateral ankle ligament injury.

Methods

Totally 50 patients with acute lateral collateral ankle ligament injury underwent high-frequency ultrasound and real-time SWE examinations. The Young's modulus and shear wave velocity (SWV) of the ligament were compared among subjects with complete rupture of the ligament, incomplete rupture of the ligament, and normal ligament.

Results

Both surgery and high-frequency ultrasound examination revealed complete rupture of the ligament in 20 cases. Nineteen cases of incomplete rupture of the ligament were confirmed by magnetic resonance imaging (MRI), of which five were misdiagnosed by ultrasound. Forty cases of contusion rupture of the ligament were confirmed by MRI. Young's modulus and SWV differed significantly among the complete, incomplete, and contusion rupture of the ligament and normal ligament (P<0.05) and between any of two groups except between the contusion rupture of the ligament and normal ligament.

Conclusion

Real-time SWE can be used as an effective supplement for high-frequency ultrasound in the diagnosis of lateral collateral ankle ligament rupture.

Key words: Shear wave elastography, Lateral collateral ankle ligament, Wound and injury, Ultrasonography

图1 左侧距腓前韧带正常声像图（箭头表示距腓前韧带）

图2 右侧距腓前韧带完全断裂声像图（箭头表示断裂处）

图3 左侧距腓前韧带不完全断裂声像图（箭头表示距腓前韧带）

图4 左侧跟腓韧带挫伤声像图（箭头表示跟腓韧带）

表1 外侧副韧带完全断裂组、部分断裂组和正常组杨氏模量值和SWV比较（±s）

组别	例数	杨氏模量值（kPa）	SWV（m/s）
完全断裂组	21	41.86±14.85	3.68±0.67
部分断裂组	19	54.95±12.48	4.25±0.52
挫伤组	40	86.03±28.17^ac	5.28±0.90^ac
正常组	100	158.29±61.98^bde	7.13±1.39^bde
F值	?	56.147	73.539
P值	?	<0.001	<0.001

表1 外侧副韧带完全断裂组、部分断裂组和正常组杨氏模量值和SWV比较（±s）

组别	例数	杨氏模量值（kPa）	SWV（m/s）
完全断裂组	21	41.86±14.85	3.68±0.67
部分断裂组	19	54.95±12.48	4.25±0.52
挫伤组	40	86.03±28.17^ac	5.28±0.90^ac
正常组	100	158.29±61.98^bde	7.13±1.39^bde
F值	?	56.147	73.539
P值	?	<0.001	<0.001

图8 距腓前韧带正常弹性测量图像

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Real-time shear wave elastography examination for evaluation of acute closed lateral collateral ankle ligament injury

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Real-time shear wave elastography examination for evaluation of acute closed lateral collateral ankle ligament injury