目的：探讨超声弹性成像（Ultrasound elastography，UE）在类风湿关节炎（Rheumatoid arthritis，RA）活动期中评估股四头肌肌腱损伤的应用价值。方法：选取40例健康志愿者（对照组）及40例RA患者，参照跟腱分段方法将股四头肌腱分为近段、中段、末段。分别使用二维超声和UE对两组的股四头肌肌腱进行检查，记录结果并进行分级，可分为Ⅰ级、Ⅱ级及Ⅲ级，Ⅰ级肌腱视为正常肌腱，Ⅱ级及Ⅲ级肌腱视为异常或受损肌腱。通过两位评估者对肌腱超声诊断分级进行一致性检验。应用SPSS 22.0对数据进行统计分析。结果：二维超声在对照组和RA活动组股四头肌肌腱各段分级异常数目中无统计学差异（P=0.173，P=0.072，P=0.242）；UE股四头肌肌腱近段分级异常数目在两组中无显著的统计学差异（P=0.093），在中段和末段分级异常数目中有显著的统计学差异（P=0.002，P=0.001）。两组在评估肌腱二维超声诊断分级的一致性较好，对照组（k=0.794，k=0.851，k=0.726），RA活动组（k=0.707，k=0.709，k=0.703）；两组在UE诊断分级近段肌腱一致性中等，对照组（k=0.576），RA活动组（k=0.574），两组在中、末段肌腱一致性较好，对照组（k=0.739，k=0.717），RA活动组（k=0.710，k=0.723）。结论：UE在评估RA活动期患者中、末段股四头肌肌腱损伤中有良好的应用价值；UE可以提供RA活动期中股四头肌肌腱硬度信息，可做为二维超声的补充检查方法。
Abstract
Objective: To investigate the value of ultrasound elastography(UE) in assessing quadriceps tendon injury of active period in rheumatoid arthritis(RA). Methods: Forty healthy volunteers(control group) and forty RA patients were selected. The quadriceps tendons were divided into proximal, middle, and distal segments. According to the achilles tendon segmentation method. Using two-dimensional ultrasound and UE to examine the quadriceps tendon of the knee joint, and the results were recorded and graded. Quadriceps tendon can be divided into grade Ⅰ, grade Ⅱ, and grade Ⅲ. Grade Ⅰ tendons were considered as normal tendons, and grade Ⅱ and grade Ⅲ tendons were considered as abnormal or damaged tendons. Consistency test for tendon ultrasound diagnostic grading were evaluated by two evaluators. SPSS 22.0 was used for statistical analysis of data. Results: The number of abnormal quadriceps tendon of each segment detected by two-dimensional ultrasound was not statistically significant between the control group and the RA active group(P=0.173, P=0.072, P=0.242). The number of abnormal quadriceps tendon of proximal segments detected by UE was not statistically significant between the two groups(P=0.093), thus, there was a statistically significant difference in the number of abnormal quadriceps tendon of middle and distal segments(P=0.002, P=0.001). The two groups had better consistency in assessing tendon grading by two-dimensional ultrasound, the control group(k=0.794, k=0.851, k=0.726), and the RA active group(k=0.707, k=0.709, k=0.703); The two groups were moderately consistent of grading of tendon of the proximal segments by UE, the control group(k=0.576), and the RA active group(k=0.574). The two groups had better consistency in the middle and distal segments of the tendon, the control group(k=0.739, k=0.717), and the RA active group(k=0.710, k=0.723). Conclusion: UE is useful in evaluating middle and distal segments quadriceps tendon injury in active RA patients; UE can provide quadriceps tendon stiffness information of RA active period, which can be used as a supplementary examination of two-dimensional ultrasound method.
关键词
关节炎 /
类风湿 /
超声检查
Key words
Arthritis, rheumatoid /
Ultrasonography
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]Xu H, Zhang Y, Zhang H, et al. Comparison of the clinical effectiveness of US grading scoring system vs MRI in the diagnosis of early rheumatoid arthritis(RA)[J]. J Orthop Surg Res, 2017, 12(1): 152.
[2]Ma Q, Yang D, Xue B, et al. Transrectal real-time tissue elastography targeted biopsy coupled with peak strain index improves the detection of clinically important prostate cancer[J]. Oncol Lett, 2017, 14(1): 210-216.
[3]Schwab F, Redling K, Siebert M, et al. Inter- and Intra-Observer Agreement in Ultrasound BI-RADS Classification and Real-Time Elastography Tsukuba Score Assessment of Breast Lesions[J]. Ultrasound Med Biol, 2016, 42(11): 2622-2629.
[4]Wu Q, Qu Y, Zang X, et al. Preliminary study of confounding factors of elastography and the application of fine-needle aspiration in thyroid nodules with indeterminate elastography[J]. Sci Rep, 2017, 7(1): 18005.
[5]Akkaya S, Akkaya N, Agladioglu K, et al. Real-time elastography of patellar tendon in patients with auto-graft bone-tendon-bone anterior cruciate ligament reconstruction[J]. Arch Orthop Trauma Surg, 2016, 136(6): 837-842.
[6]Evranos B, Idilman I, Ipek A, et al. Real-time sonoelastography and ultrasound evaluation of the Achilles tendon in patients with diabetes with or without foot ulcers: a cross sectional study[J]. J Diabetes Complications, 2015, 29(8): 1124-1129.
[7]Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative[J]. Arthritis Rheum, 2010, 62(9): 2569-2581.
[8]Fransen J, van Riel PL. The Disease Activity Score and the EULAR response criteria[J]. Rheum Dis Clin North Am, 2009, 35(4): 745-757.
[9]De Zordo T, Fink C, Feuchtner GM, et al. Real-time sonoelastography findings in healthy Achilles tendons[J]. Am J Roentgenol, 2009, 193(2): W134-138.
[10]唐国桂，张继春，王延根. CT对膝关节周围滑膜囊积液的定位诊断价值[J]. 上海医学影像，2005，14（1）：27-28.
[11]Klauser AS, Miyamoto H, Tamegger M, et al. Achilles tendon assessed with sonoelastography: histologic agreement[J]. Radiology, 2013, 267(3): 837-842.
[12]Teber MA, Ogur T, Bozkurt A, et al. Real-time Sonoelastography of the Quadriceps Tendon in Patients Undergoing Chronic Hemodialysis[J]. J Ultrasound Med, 2015, 34(4): 671-677.
[13]Meester S, Lee S. Spontaneous bilateral quadriceps tendon rupture[J]. Am J Emerg Med, 2018, 36(6): 1123.e5-1123.e7.
[14]Matschke V, Jones JG, Lemmey AB, et al. Patellar tendon properties and lower limb function in rheumatoid arthritis and ankylosing spondylitis versus healthy controls: a cross-sectional study[J]. Scientific World Journal, 2013, 2013: 1-8.
[15]Frediani B, Falsetti P, Storri L, et al. Ultrasound and clinical evaluation of quadricipital tendon enthesitis in patients with psoriatic arthritis and rheumatoid arthritis[J]. Clin Rheumatol, 2002, 21(3): 203-206.
[16]Ozcan ANS, Tan S, Tangal NG, et al. Real-time sonoelastography of the patellar and quadriceps tendons: pattern description in profesional athletes and healthy volunteers[J]. Med Ultrason, 2016, 18(3): 299-304.
