| PartⅠ The value of high frequency ultrasound combined with shear wave elastography in the evaluation of normal finger tendon and stiffnessOBJECTIVE:To explore the value of high-frequency ultrasound(ultrasound,US)combined with shear wave elastography(SWE)in the evaluation of the normal image characteristics and stiffness of the flexor tendons and extensor tendons of healthy volunteers.METHODS:From January 2020 to January 2021,high-frequency ultrasound combined with elastic imaging technology was used to observe the normal image characteristics of124 finger extensor tendons and 124 finger flexor tendons in 62 healthy volunteers,and measure their thickness;The normal range of tendon shear wave velocity(SWV),including 30 males and 32 females.We analyze the SWV differences of the extensor tendons and flexor tendons in tension and tension-free respectively,and the left and right SWV in the same state.The difference of SWV between different genders in the same state of the finger flexor tendon and the finger extensor tendon,and the comparison of the SWV difference between adding a coupling pad to the finger extensor tendon and direct scanning.RESULTS:(1)The normal image characteristics of the ultrasonic longitudinal section of the finger tendons are as follows: the extensor finger tendons are slender,thin,and band-shaped with hyperechoic,and the finger flexor tendons are multi-layer parallel thin strips with hyperechoic,with a few thin strips of hypoechoic in between.Smooth and continuous,with clear boundaries with surrounding tissues;the thickness of the finger extensor tendons of 124 healthy volunteers was0.93±0.18 mm,and the thickness of the finger flexor tendons was 3.31±0.24 mm.(2)Comparison of SWV of finger tendons in different states: 124 normal finger extensor tendons have a SWV of 4.82±1.35m/s under tension and a SWV of3.60±0.89m/s under tension-free.The difference is statistically significant.Significance(p<0.05);124 normal finger flexor tendons have a SWV of4.34±1.03m/s under tension and a SWV of 2.89±0.94m/s under tension-free.The difference between the two is statistically significant(p<0.05).(3)Comparison of bilateral SWV of finger tendons: The difference between SWV on the left and right of the finger flexor tendon under tension is statistically significant(p<0.05),but compared with the SWV on both sides of the finger flexor tendon under tension-free,The difference was not statistically significant(p>0.05);there was no significant difference between the SWV of the extensor tendons in the same state(p>0.05).(4)Comparison of SWV of finger tendons of different genders: The SWV value of 60 male finger flexor tendons and 64 female finger flexor tendons under the same state are statistically significant(p<0.05);while the SWV value of finger extensor tendons under the same state The difference was not statistically significant(p>0.05).(5)There was a statistically significant difference between adding a coupling pad under the tension state and the tension-free state of the extensor tendon compared with direct scanning SWV(p<0.05).CONCLUSION:(1)High-frequency ultrasound combined with shear wave elastography can observe the characteristics of the normal sonographic image of the finger tendon,measure the thickness of the normal tendon,and more importantly,can evaluate its hardness.It is a simple and reliable imaging method for evaluating finger tendons.(2)High-frequency ultrasound combined with shear wave elastography can observe the characteristics of the normal sonographic image,and measure finger tendon thickness and SWV,provides an accurate,non-invasive and quantitative objective evaluation method for clinical diagnosis of finger tendon injury and assessment of the structure and function recovery after repair of finger tendon rupture.Part Ⅱ Application value of high-frequency ultrasound combined with shear wave elastography in evaluating structural and functional recovery after repair of finger tendon ruptureOBJECTIVE :To explore the use of high-frequency ultrasound(Ultrasound,US)combined with shear wave elastography technology in the flexor digitorum profundus(FDP),the flexor digitorum superficialis(FDS),and the finger extensor tendon(FET)after repairing,evaluate the repair effect of its structure,function and hardness,and guide functional exercise of the application value.METHODS:Between January 2018 to February 2021,68 finger tendons of 50 patients underwent finger tendon rupture repair in the People’s Hospital of Jiangsu University and the Zhenjiang Medical District of the Eastern Theater General Hospital.Use high-frequency ultrasound to track and follow up the image characteristics of the repaired area at 3 days,2 weeks,4 weeks,and 12 weeks after the repair of the finger tendon rupture,measure the hardness,and observe the movement of the repaired tendon dynamically in real time,measure the sliding distance of the tendon,evaluate the repair effect according to the image characteristics and hardness changes,and more importantly,guide the clinical rehabilitation training of finger functions.The evaluation indicators include:(1)Ultrasound assessment at 3d-12 weeks postoperatively,ultrasonic assessment of tendon structure repair,measurement of tendon sliding distance,and SWE assessment of tendon stiffness changes.(2)Clinical assessment of total active range of motion(TAM).The correlation between TAM and ultrasonic measurement index adopts Pearson correlation analysis.RESULTS:(1)After repair of finger tendon rupture,the repair effect is good.The ultrasound image shows that the repair area is edema in the early stage.The two-dimensional ultrasound image shows the local thickened hypoechoic area,the normal linear hyperechoic muscle fiber structure disappears,and the edge is not clear.If the stump is tightly aligned,no gap is formed at the tendon anastomosis or the gap is less than 3mm.The activity test showed that the fingers were slightly flexed and stretched,and the repaired area tendons to slide proximally;Early Color Doppler Flow Imaging(CDFI)showed that the local blood flow signal increased.With the repair of the postoperative tendon,the local blood flow signal gradually decreased.The ultrasound image of poor repair is as follows: the width of the gap in the tendon repair area is greater than 3mm.When the finger is flexed and extended,the gap is enlarged and the display is clearer,and the proximal tendon has no obvious sliding;(2)The results of this study show 48(74%)of the finger tendon ruptures were repaired for 4 weeks after the repair,the echo of the repaired area was close to the echo of the normal tendon,the edge was clear,the thickness was close to the normal tendon,and the flexor and extensor finger tendons slipped better.CDFI: blood flow signal decreased earlier.At 12 weeks,the adhesion between the tendon and the surrounding tissues was judged according to the ultrasonic evaluation of the sliding distance of the tendon.There were 55 without adhesion,7 with mild adhesion,and 3 with severe adhesion;(3)The SWV of the normal finger flexor tendons without tension was2.89±0.94m/s,the SWV of 45 finger flexor tendons was 1.78±0.22m/s at 4 weeks after the repair,and the SWV at 12 weeks was 2.37±0.31m/s.The difference between normal people and the 12 weeks after the flexor tendon repair,and the 4 weeks and 12 weeks after the flexor tendon repair were statistically significant(p<0.05);the normal SWV of the finger extensor tendon was 3.60± At 0.89m/s,the SWV of 20 extensor tendons was 2.08±0.18m/s at 4 weeks after repair,and the SWV was 2.78±0.21m/s at12 weeks.The difference between normal people and the 12 weeks after the extensor tendon repair,and the 4 weeks and 12 weeks after the extensor tendon repair were statistically significant(p<0.05);(4)TAM assessment of finger function at 12 weeks after operation included 74%(48/ 65 roots)were excellent;11%(7/65 roots)were good;11%(7/65 roots)were fair;4%(3/65 roots)were poor.(5)Various items after repair of finger tendon rupture In the observation index,the sliding distance of the tendon has a good correlation with the total active range of motion(TAM)of the finger(r=0.790,p<0.05).CONCLUSION:High-frequency ultrasound is currently a reliable imaging evaluation method for observing the healing process after repairing finger tendon ruptures.It can observe changes in tendon echo,morphology,thickness,edge,gap size,blood flow distribution,and dynamics at all stages after surgery.Observe the sliding condition of the tendon,SWE evaluates the change of its hardness,provides an objective evaluation method for the structure and function recovery after the repair of the finger tendon rupture,provides an objective basis for rehabilitation training,and guides the clinic to conduct timely and appropriate rehabilitation training.Conducive to the recovery of finger function.At 12 weeks after the operation,the ultrasonic measurement of the sliding distance of the tendon has a good correlation with TAM.Therefore,the ultrasound evaluation of the adhesion degree after the repair of the tendon rupture is consistent with the clinical evaluation of finger function. |
