肌肉骨骼超声技术在骨科诊断治疗中的应用现状及机制
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摘要
背景:随着肌肉骨骼超声技术(以下简称肌骨超声)的成熟,其在骨科诊断的应用越来越广泛。目的:回顾分析近年来肌骨超声在肌肉与肌腱、骨与软骨、关节、神经等疾病诊断中的应用现状,阐述其原理及优缺点。方法:第一作者以"肌肉骨骼超声,骨科"为中文检索词,以"Musculoskeletal ultrasound,Orthopedics"为英文检索词,采用计算机检索中国知网数据库(CNKI)和PubMed数据库、Elsevier数据库2013至2018年的相关文章,筛选有关肌骨超声在骨科诊断中的应用文章44篇进行讨论、综述。结果与结论:①肌骨超声在诊断肌肉、肌腱、筋膜等软组织疾病,以及排查隐匿性骨折、早期各类关节炎等骨与关节疾病时,因其简便价廉,灵敏度高,无辐射的优点,优于MRI和CT;②同时由于其可动态分析肌肉、骨骼等运动情况,观察外周神经变化,可作为术后判断功能恢复及外周神经损伤的首选检查;③在未来将肌骨超声用于诊断延迟性肌肉酸痛和量化肌腱异常从而探究肌腱损伤病因将是新的研究方向。
BACKGROUND: With the maturation of musculoskeletal ultrasound, it is widely used in orthopedic diagnosis.OBJECTIVE: To review the application status of musculoskeletal ultrasound in the diagnosis of muscle and tendon, bone and cartilage, joint and nerve in recent years, and to explain its principle, advantages and disadvantages.METHODS: "Musculoskeletal ultrasound, orthopedics" in Chinese and English, respectively were as keywords to retrieve in CNKI, PubMed databases, and Elsevier databases for the articles published from 2013 to 2018. Forty-four articles about the application of musculoskeletal ultrasound in orthopedic diagnosis were reviewed.RESULTS AND CONCLUSION:(1) In the diagnosis of soft tissue diseases such as muscle, tendon, fascia and other soft tissue diseases, as well as in the examination of occult fractures, early arthritis and other diseases of bone and joint, musculoskeletal ultrasound is superior to MRI and CT, because it is simple, cheap, has high sensitivity and no radiation.(2) It can be used as the first choice to judge the recovery of function and the injury of peripheral nerve after operation because it can dynamically analyze the movement of muscles and bones and observe the changes of peripheral nerve.(3) In the future, the application of musculoskeletal ultrasound in the diagnosis of delayed muscle soreness and quantification of tendon abnormalities will be a new research direction.
BACKGROUND: With the maturation of musculoskeletal ultrasound, it is widely used in orthopedic diagnosis.OBJECTIVE: To review the application status of musculoskeletal ultrasound in the diagnosis of muscle and tendon, bone and cartilage, joint and nerve in recent years, and to explain its principle, advantages and disadvantages.METHODS: "Musculoskeletal ultrasound, orthopedics" in Chinese and English, respectively were as keywords to retrieve in CNKI, PubMed databases, and Elsevier databases for the articles published from 2013 to 2018. Forty-four articles about the application of musculoskeletal ultrasound in orthopedic diagnosis were reviewed.RESULTS AND CONCLUSION:(1) In the diagnosis of soft tissue diseases such as muscle, tendon, fascia and other soft tissue diseases, as well as in the examination of occult fractures, early arthritis and other diseases of bone and joint, musculoskeletal ultrasound is superior to MRI and CT, because it is simple, cheap, has high sensitivity and no radiation.(2) It can be used as the first choice to judge the recovery of function and the injury of peripheral nerve after operation because it can dynamically analyze the movement of muscles and bones and observe the changes of peripheral nerve.(3) In the future, the application of musculoskeletal ultrasound in the diagnosis of delayed muscle soreness and quantification of tendon abnormalities will be a new research direction.
引文
[1]McDonald DG,Leopold GR.Ultrasound B-scanning in the differentiation of Baker's cyst and thrombophlebitis.Br JRadiol.1972;45(538):729-732.
[2]张光,马千里,李先海.影像学诊断与技术[M].哈尔滨:黑龙江科学技术出版社,1900.
[3]王智勇,钟秀,张云凤.医学影像学在临床骨科中的应用进展[J].中国卫生产业,2016,13(27):196-198.
[4]张文静,刘志成,高玉,等.基于肌骨超声技术评价循经筋阿是穴治疗膝骨性关节炎的临床疗效观察[J].世界中西医结合杂志,2014,9(8):834-836.
[5]吴筱辉.超声在肌肉肌腱及软组织检查中的应用[J].浙江临床医学,2001,3(4):298.
[6]Todorov PT.Ultrasonographic study of the piriformis muscle and sonographic features of the piriformis syndrome in chronic low back pain.Ann Rheum Dis.2014;Suppl 2(73):303-304.
[7]贺亭.梨状肌综合征的超声诊断探讨[D].南宁:广西医科大学,2016.
[8]赵俊,韩龄锋.梨状肌综合征的超声表现分析[J].中国中西医结合影像学杂志,2018,16(1):89-91.
[9]Watanabe T,Murakami H,Fukuoka D,et al.Quantitative Sonographic Assessment of the Quadriceps Femoris Muscle in Healthy Japanese Adults.J Ultrasound Med.2017;36(7):1383-1395.
[10]Xiao YT,Function DO.Diagnostic value of musculoskeletal ultrasonography in chronic plantar fasciitis.Hainan Med J.2017.
[11]Longo V,Jacobson JA,Fessell DP,et al.Ultrasound Findings of Delayed-Onset Muscle Soreness.J Ultrasound Med.2016;35(11):2517-2521.
[12]Langen E,Lee H,Park M,et al.Diagnositic utility of ultrasound and MRI in women with placenta previa and placental invasion.Am J Obst Gynecol.2011;204(1):S137.
[13]Tamborrini G,Marx C,Micheroli R.FRI0588 3D VS 2Dmusculoskeletal ultrasound of supraspinate tendon tears.Ann Rheum Dis.2015;2(74):640-641.
[14]Lee SC,Williams D,Endo Y.The Repaired rotator cuff:mri and ultrasound evaluation.Curr Rev Musculoskelet Med,2018;11(1):92-101.
[15]Bogaerts S,De Brito CC,Scheys L,et al.Evaluation of tissue displacement and regional strain in the Achilles tendon using quantitative high-frequency ultrasound.PLoS One.2017;12(7):e181364.
[16]McAuliffe S,McCreesh K,Culloty F,et al.Can ultrasound imaging predict the development of Achilles and patellar tendinopathy?A systematic review and meta-analysis.Br JSports Med.2016;50(24):1516-1523.
[17]Ooi CC,Schneider ME,Malliaras P,et al.Diagnostic performance of axial-strain sonoelastography in confirming clinically diagnosed Achilles tendinopathy:comparison with B-mode ultrasound and color Doppler imaging.Ultrasound Med Biol.2015;41(1):15-25.
[18]Morgan TA,Piper SL,Lattanza LL,et al.Distal forearm fracture open reduction-internal fixation:sonographic detection of hardware malalignment and associated tendon injuries missed by radiography.J Ultrasound Med.2017;36(10):2173-2177.
[19]Ohrndorf S,Backhaus M.Musculoskeletal ultrasonography in patients with rheumatoid arthritis.Nat Rev Rheumatol.2013;9(7):433-437.
[20]Luz KR,Pinheiro MM,Petterle GS,et al.A new musculoskeletal ultrasound scoring system(US10)of the hands and wrist joints for evaluation of early rheumatoid arthritis patients.Rev Bras Reumatol Engl Ed.2016;56(5):421-431.
[21]马艳,金莉,李向培,等.高频超声在类风湿关节炎双手关节病变的应用价值[J].实用医学杂志,2016,32(11):1810-1812.
[22]Bauer EM,Ben-Artzi A,Duffy EL,et al.Joint-specific assessment of swelling and power Doppler in obese rheumatoid arthritis patients.BMC Musculoskelet Disord.2017;18(1):99.
[23]陈秀晓,吴圆圆,隋文倩.肌骨超声在类风湿关节炎评估中的应用价值分析[J].中国继续医学教育,2017,9(19):64-65.
[24]Sifuentes-Cantu C,Contreras-Yanez I,Saldarriaga L,et al.The added value of musculoskeletal ultrasound to clinical evaluation in the treatment decision of rheumatoid arthritis outpatients:physician experience matters.BMCMusculoskelet Disord.2017;18(1):390.
[25]张栋,王庆甫,石鑫超,等.膝骨关节炎肌骨超声与X线片表现的比较与分析[J].中国骨伤,2016,29(5):429-433.
[26]黄丽娜.痛风性关节炎患者的肌肉骨骼超声表现及其临床诊断价值[J].包头医学院学报,2017,33(6):40-42.
[27]肖岚,李素淑.高频超声诊断急性踝内翻外侧副韧带损伤的临床价值[J].中国医疗设备,2016,31(6):62-64.
[28]陈征,李建国,陈思,等.急性踝内翻扭伤的超声检查和诊断探讨[J].中国超声医学杂志,2014,30(10):933-936.
[29]黄丹,何秀珍,杨旭欢,等.高频超声分层诊断踝关节外侧副韧带3种损伤类型的价值:前瞻性,单中心,诊断性试验方案及预试验结果[J].中国组织工程研究,2018,22(23):3681-3686.
[30]杨阳,张瑞,刘纯红.肌骨超声评估颈椎钩椎关节增生的效度研究[J].中国社区医师,2017,33(24):90-92.
[31]吴言,杜国庆,杜佩,等.膝关节软骨及滑膜病变:超声诊断的常见误区与鉴别思路[J].中国组织工程研究,2015,19(15):2436-2441.
[32]Nguyen S,Lu X,Ma Y,et al.Musculoskeletal ultrasound for intra-articular bleed detection:a highly sensitive imaging modality compared with conventional magnetic resonance imaging.J Thromb Haemost.2018;16(3):490-499.
[33]赵丽,赵胜军,徐洪.高频超声在急诊创伤骨折中诊断价值研究[J].临床军医杂志,2018,46(7):759-762.
[34]Lau BC,Robertson A,Motamedi D,et al.The validity and reliability of a pocket-sized ultrasound to diagnose distal radius fracture and assess quality of closed reduction.J Hand Surg Am.2017;42(6):420-427.
[35]Muresan S,Muresan M,Voidazan S,et al.The accuracy of musculoskeletal ultrasound examination for the exploration of meniscus injuries in athletes.J Sports Med Phys Fitness.2017;57(5):589-594.
[36]Bortolotto C,Federici E,Draghi F,et al.Sonographic diagnosis of a radiographically occult displaced fracture of a costal cartilage.J Clin Ultrasound.2017;45(9):605-607.
[37]黄丽,高峰,罗庆华.高频超声在急诊肋骨及肋软骨骨折中的临床应用[J].中国医学物理学杂志,2018,35(1):106-109.
[38]Maeda M,Maeda N,Takaoka T,et al.Sonographic Findings of Chondral Avulsion Fractures of the Lateral Ankle Ligaments in Children.J Ultrasound Med.2017;36(2):421-432.
[39]宋升.新兵胫骨应力性损伤的高频超声和MRI对照研究[D].南京:江苏大学,2009.
[40]Connor C,Weinik MM.Poster 221 the preoperative role of musculoskeletal ultrasound in evaluation for ulnar nerve transposition:a case report.PMR.2014;9(6):S262-S263.
[41]王战业,曹洪弘,夏炳兰.高频超声检查在外周神经医源性损伤诊断中的应用[J].现代医学,2016,44(6):823-825.
[42]古旸,何芳,梁嘉樑,等.高频超声对上肢骨折后出现周围神经损伤的诊断价值[J].临床超声医学杂志,2016,18(12):855-856.
[43]张玉玲.高频超声技术在桡神经损伤诊断中的应用价值[J].中国实用神经疾病杂志,2017,20(9):91-93.
[44]郭云怀,高博,马力,等.高频超声在外周神经损伤中的应用价值[J].医学影像学杂志,2017,27(4):729-731.
[2]张光,马千里,李先海.影像学诊断与技术[M].哈尔滨:黑龙江科学技术出版社,1900.
[3]王智勇,钟秀,张云凤.医学影像学在临床骨科中的应用进展[J].中国卫生产业,2016,13(27):196-198.
[4]张文静,刘志成,高玉,等.基于肌骨超声技术评价循经筋阿是穴治疗膝骨性关节炎的临床疗效观察[J].世界中西医结合杂志,2014,9(8):834-836.
[5]吴筱辉.超声在肌肉肌腱及软组织检查中的应用[J].浙江临床医学,2001,3(4):298.
[6]Todorov PT.Ultrasonographic study of the piriformis muscle and sonographic features of the piriformis syndrome in chronic low back pain.Ann Rheum Dis.2014;Suppl 2(73):303-304.
[7]贺亭.梨状肌综合征的超声诊断探讨[D].南宁:广西医科大学,2016.
[8]赵俊,韩龄锋.梨状肌综合征的超声表现分析[J].中国中西医结合影像学杂志,2018,16(1):89-91.
[9]Watanabe T,Murakami H,Fukuoka D,et al.Quantitative Sonographic Assessment of the Quadriceps Femoris Muscle in Healthy Japanese Adults.J Ultrasound Med.2017;36(7):1383-1395.
[10]Xiao YT,Function DO.Diagnostic value of musculoskeletal ultrasonography in chronic plantar fasciitis.Hainan Med J.2017.
[11]Longo V,Jacobson JA,Fessell DP,et al.Ultrasound Findings of Delayed-Onset Muscle Soreness.J Ultrasound Med.2016;35(11):2517-2521.
[12]Langen E,Lee H,Park M,et al.Diagnositic utility of ultrasound and MRI in women with placenta previa and placental invasion.Am J Obst Gynecol.2011;204(1):S137.
[13]Tamborrini G,Marx C,Micheroli R.FRI0588 3D VS 2Dmusculoskeletal ultrasound of supraspinate tendon tears.Ann Rheum Dis.2015;2(74):640-641.
[14]Lee SC,Williams D,Endo Y.The Repaired rotator cuff:mri and ultrasound evaluation.Curr Rev Musculoskelet Med,2018;11(1):92-101.
[15]Bogaerts S,De Brito CC,Scheys L,et al.Evaluation of tissue displacement and regional strain in the Achilles tendon using quantitative high-frequency ultrasound.PLoS One.2017;12(7):e181364.
[16]McAuliffe S,McCreesh K,Culloty F,et al.Can ultrasound imaging predict the development of Achilles and patellar tendinopathy?A systematic review and meta-analysis.Br JSports Med.2016;50(24):1516-1523.
[17]Ooi CC,Schneider ME,Malliaras P,et al.Diagnostic performance of axial-strain sonoelastography in confirming clinically diagnosed Achilles tendinopathy:comparison with B-mode ultrasound and color Doppler imaging.Ultrasound Med Biol.2015;41(1):15-25.
[18]Morgan TA,Piper SL,Lattanza LL,et al.Distal forearm fracture open reduction-internal fixation:sonographic detection of hardware malalignment and associated tendon injuries missed by radiography.J Ultrasound Med.2017;36(10):2173-2177.
[19]Ohrndorf S,Backhaus M.Musculoskeletal ultrasonography in patients with rheumatoid arthritis.Nat Rev Rheumatol.2013;9(7):433-437.
[20]Luz KR,Pinheiro MM,Petterle GS,et al.A new musculoskeletal ultrasound scoring system(US10)of the hands and wrist joints for evaluation of early rheumatoid arthritis patients.Rev Bras Reumatol Engl Ed.2016;56(5):421-431.
[21]马艳,金莉,李向培,等.高频超声在类风湿关节炎双手关节病变的应用价值[J].实用医学杂志,2016,32(11):1810-1812.
[22]Bauer EM,Ben-Artzi A,Duffy EL,et al.Joint-specific assessment of swelling and power Doppler in obese rheumatoid arthritis patients.BMC Musculoskelet Disord.2017;18(1):99.
[23]陈秀晓,吴圆圆,隋文倩.肌骨超声在类风湿关节炎评估中的应用价值分析[J].中国继续医学教育,2017,9(19):64-65.
[24]Sifuentes-Cantu C,Contreras-Yanez I,Saldarriaga L,et al.The added value of musculoskeletal ultrasound to clinical evaluation in the treatment decision of rheumatoid arthritis outpatients:physician experience matters.BMCMusculoskelet Disord.2017;18(1):390.
[25]张栋,王庆甫,石鑫超,等.膝骨关节炎肌骨超声与X线片表现的比较与分析[J].中国骨伤,2016,29(5):429-433.
[26]黄丽娜.痛风性关节炎患者的肌肉骨骼超声表现及其临床诊断价值[J].包头医学院学报,2017,33(6):40-42.
[27]肖岚,李素淑.高频超声诊断急性踝内翻外侧副韧带损伤的临床价值[J].中国医疗设备,2016,31(6):62-64.
[28]陈征,李建国,陈思,等.急性踝内翻扭伤的超声检查和诊断探讨[J].中国超声医学杂志,2014,30(10):933-936.
[29]黄丹,何秀珍,杨旭欢,等.高频超声分层诊断踝关节外侧副韧带3种损伤类型的价值:前瞻性,单中心,诊断性试验方案及预试验结果[J].中国组织工程研究,2018,22(23):3681-3686.
[30]杨阳,张瑞,刘纯红.肌骨超声评估颈椎钩椎关节增生的效度研究[J].中国社区医师,2017,33(24):90-92.
[31]吴言,杜国庆,杜佩,等.膝关节软骨及滑膜病变:超声诊断的常见误区与鉴别思路[J].中国组织工程研究,2015,19(15):2436-2441.
[32]Nguyen S,Lu X,Ma Y,et al.Musculoskeletal ultrasound for intra-articular bleed detection:a highly sensitive imaging modality compared with conventional magnetic resonance imaging.J Thromb Haemost.2018;16(3):490-499.
[33]赵丽,赵胜军,徐洪.高频超声在急诊创伤骨折中诊断价值研究[J].临床军医杂志,2018,46(7):759-762.
[34]Lau BC,Robertson A,Motamedi D,et al.The validity and reliability of a pocket-sized ultrasound to diagnose distal radius fracture and assess quality of closed reduction.J Hand Surg Am.2017;42(6):420-427.
[35]Muresan S,Muresan M,Voidazan S,et al.The accuracy of musculoskeletal ultrasound examination for the exploration of meniscus injuries in athletes.J Sports Med Phys Fitness.2017;57(5):589-594.
[36]Bortolotto C,Federici E,Draghi F,et al.Sonographic diagnosis of a radiographically occult displaced fracture of a costal cartilage.J Clin Ultrasound.2017;45(9):605-607.
[37]黄丽,高峰,罗庆华.高频超声在急诊肋骨及肋软骨骨折中的临床应用[J].中国医学物理学杂志,2018,35(1):106-109.
[38]Maeda M,Maeda N,Takaoka T,et al.Sonographic Findings of Chondral Avulsion Fractures of the Lateral Ankle Ligaments in Children.J Ultrasound Med.2017;36(2):421-432.
[39]宋升.新兵胫骨应力性损伤的高频超声和MRI对照研究[D].南京:江苏大学,2009.
[40]Connor C,Weinik MM.Poster 221 the preoperative role of musculoskeletal ultrasound in evaluation for ulnar nerve transposition:a case report.PMR.2014;9(6):S262-S263.
[41]王战业,曹洪弘,夏炳兰.高频超声检查在外周神经医源性损伤诊断中的应用[J].现代医学,2016,44(6):823-825.
[42]古旸,何芳,梁嘉樑,等.高频超声对上肢骨折后出现周围神经损伤的诊断价值[J].临床超声医学杂志,2016,18(12):855-856.
[43]张玉玲.高频超声技术在桡神经损伤诊断中的应用价值[J].中国实用神经疾病杂志,2017,20(9):91-93.
[44]郭云怀,高博,马力,等.高频超声在外周神经损伤中的应用价值[J].医学影像学杂志,2017,27(4):729-731.