Diagnostic Effect and Imaging Characteristics of High Frequency Ultrasound in Limb Skeletal Muscle Injury
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摘要:
目的 探讨高频超声在肢体骨骼肌肉损伤中的诊断效果及影像学特点。 方法 选取2019年1月至2020年6月云南圣约翰医院收治的肢体肌肉骨骼损伤患者72例，对所有患者均行高频超声检查和增强CT扫描，绘制ROC曲线，分析高频超声、增强CT在肢体骨骼肌肉损伤患者中的诊断效能，并分析及影像学特点。 结果 高频超声与增强CT在血管损伤中检出率，差异无统计意义（P > 0.05），高频超声诊断在肌肉损伤、骨骼损伤、及神经损伤检出率均高于增强CT诊断，差异有统计学意义（P < 0.05）；高频超声联合增强CT诊断灵敏度、特异度均优于单一高频超声、增强CT诊断，差异有统计学意义（P < 0.05），高频超声诊断灵敏度、特异度优于增强CT诊断，差异有统计学意义（P < 0.05）；高频超声下主要表现为软骨回声连续性中断、断面边缘整齐、骨折处可见错位、周围软组织可随之出现肿胀或血肿，无回声及低回声，随时间推移，肌肉内出现高回声的骨化性肌炎；表现为神经的线样强回声连续性中断，中断区呈低回声或无回声，断端可肿胀增厚或回缩呈梭形低回声。 结论 高频超声在骨骼肌肉损伤中的诊断效果较好，联合增强CT诊断能获得较高的诊断灵敏度与特异度，能为临床诊疗提供影像学依据。 Abstract:Objective To investigate the diagnostic effect and imaging characteristics of high-frequency ultrasound in skeletal muscle injury of limbs. Methods Seventy-two patients with limb musculoskeletal injury after major exercise admitted to Yunnan St.John's Hospital from January 2019 to June 2020 were selected. CT diagnosis and high-frequency ultrasound diagnosis were performed on all patients.The clinical effect, diagnostic efficacy, specificity, sensitivity, accuracy of CT, high-frequency ultrasound and the combination of the two diagnostic methods were compared, as well as the recognition of the two diagnostic methods by clinicians, the sonographic characteristics of muscle injury and the sonographic characteristics of bone injury. Results There was no statistical significance between high frequency ultrasound and CT in the detection rate of vascular injury （P > 0.05）.The detection rates of muscle injury, bone injury and nerve injury were higher than those of CT diagnosis （P < 0.05）. The diagnostic sensitivity and specificity of high-frequency ultrasound combined with CT were better than that of single high-frequency ultrasound and CT （P < 0.05）. The diagnostic sensitivity and specificity of high-frequency ultrasound were better than that of CT （P < 0.05）. The practicability, economy, safety and accuracy of high-frequency ultrasound were higher than that of CT （P < 0.05）. Under high-frequency ultrasound, the main manifestations were broken cartilage echo continuity, neat section edge, visible dislocation at fracture, and swelling or hematoma in surrounding soft tissue. It is characterized by linear strong echo continuity interruption of nerve, and the interrupted area is hypoechoic or non-echoic.The broken end can be swollen and thickened or retracted with spindle hypoechoic shape. Conclusion High frequency ultrasound has good diagnostic effect in skeletal muscle injury, and can obtain high diagnostic sensitivity.It can provide scientific basis and guiding value for clinical treatment, and is worthy of popularization and application. -
图 1 高频超声与增强CT及二者联合在骨骼肌肉损伤患者中的诊断ROC曲线
Figure 1. The diagnostic ROC curve of high-frequency ultrasound and CT and the combination of the two in patients with skeletal muscle injury
图 2 典型病例超声图像
A：肌肉损伤高频超声图像；B：骨骼、神经损伤超声长轴图像；C：骨骼、神经损伤后短轴超声图像（B/C图片来源于席占国老师）；D：血管损伤超声图像。
Figure 2. Ultrasound image of a typical case
表 1 高频超声与增强CT在骨骼肌肉损伤患者中检出率比较[n（%）]
Table 1. Comparison of the detection rate of high-frequency ultrasound and CT in patients with skeletal muscle injury [n（%）]
检查方法 n 肌肉损伤 骨骼损伤 血管损伤 神经损伤 高频超声 72 43（59.72） 34（47.22） 16（22.22） 24（33.33） 增强CT检查 72 31（43.06） 21（29.17） 15（20.83） 12（16.67） χ2 / 6.323 7.015 1.437 7.836 P / 0.024 0.021 0.681 0.019 
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表 2 高频超声与增强CT及二者联合在骨骼肌肉损伤患者中的诊断效能比较
Table 2. Comparison of diagnostic efficacy of high-frequency ultrasound，CT and the combination of the two in patients with skeletal muscle injury
检测变量 AUC 标准误差 P 95%可信区间 敏感性 特异性 下限 上限 增强CT检查 0.746 0.061 0.001 0.713 0.858 0.794 0.671 高频超声 0.851 0.081 0.001 0.812 0.895 0.862 0.641 联合检查 0.894 0.083 0.001 0.845 0.932 0.931 0.612
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