冲击波治疗髌腱腱病影像变化及疗效研究

发布时间：2018-03-16 00:24

本文选题：冲击波　切入点：髌腱腱病　出处：《北京体育大学》2015年博士论文　论文类型：学位论文

【摘要】：目的：本研究通过观察冲击波治疗髌腱腱病的疗效和超声影像变化,验证冲击波治疗髌腱腱病是否能够消除症状、改善功能和促进髌腱组织重新修复,从宏观上探讨冲击波治疗髌腱腱病的作用原理,以及肌骨超声在髌腱腱病诊断、治疗定位和疗效评估中的运用。方法：髌腱腱病患者65例,随机分为治疗组33例和对照组32例,治疗组予放射状冲击波治疗,每周1次,共治疗5次。对照组予休息干预。通过VAS、VISA、Lysholm、2000IKDC评分观察症状和功能的变化,采用肌骨超声观察髌腱组织结构影像学变化,进行9个月连续跟踪随访。结果：1.VAS评分：9个月后,治疗组和对照组VAS评分均显著降低(P0.05),治疗组优于对照组(P0.05)。2. VISA、Lysholm、2000 IKDC评分：9个月后,治疗组和对照组评分均显著升高(P0.01),治疗组优于对照组(P0.01)。3.超声评估：①髌腱长度。干预前患侧髌腱长度长于健侧(P0.05),6个月后,患侧髌腱长度显著降低(P0.01),治疗组髌腱长度显著降低(P0.05),对照组髌腱长度变化不明显(P0.05)。②髌腱厚度。干预前患侧髌腱上、下厚度均高于健侧(P0.05),6个月后,患侧髌腱上、下厚度显著降低(P0.05),治疗组髌腱上、下厚度显著降低(P0.05),对照组髌腱上、下厚度降低不明显(P0.05)。③低回声面积。6个月后,治疗组髌腱低回声面显著降低(P0.01),对照组髌腱低回声面积显著降低(P0.05),治疗组优于对照组(P0.01)。④钙化面积。6个月后,治疗组髌腱钙化面积显著降低(P0.01),对照组髌腱钙化面积降低不明显(P0.05),治疗组优于对照组(P0.05)。⑤血流信号。治疗组第1次治疗后,血流信号显著增加(P0.01),3个月、6个月后血流信号显著减少(P0.01),对照组血流信号显著减少(P0.05),治疗组优于对照组(P0.01)。结论：1.冲击波和休息对髌腱腱病均有一定的疗效,冲击波治疗配合休息优于单纯休息。2.冲击波治疗和休息均能引起髌腱组织形态学的变化,冲击波治疗配合休息优于单纯休息。3.冲击波治疗髌腱腱病具有标本兼治的作用。4.肌骨超声不仅可以用于髌腱腱病的诊断和治疗定位,还可以用于髌腱腱病的疗效评估。
[Abstract]:Objective: to observe the effect of shock wave on patellar tendon disease and the changes of ultrasonic images, to verify whether shock wave treatment can eliminate symptoms, improve function and promote patellar tendon tissue repair. The principle of shock wave in the treatment of patellar tendon disease and the application of bone ultrasound in the diagnosis, treatment localization and curative effect evaluation of patellar tendon disease were discussed. Methods: 65 patients with patellar tendon disease were randomly divided into treatment group (n = 33) and control group (n = 32). The treatment group was treated with radial shock wave once a week for 5 times. The control group was treated with rest intervention. The changes of symptoms and functions were observed by VAS-VISA-Lysholm 2000 IKDC score, and the imaging changes of patellar tendon tissue structure were observed by musculoskeletal ultrasound. Results 1. VAS score: after 9 months, the VAS score of both the treatment group and the control group decreased significantly, and the treatment group was superior to the control group (P 0.05) .2.VISAN Lysholmma 2000 IKDC score: 9 months later, there was no significant difference between the two groups. The scores of both the treatment group and the control group were significantly higher than that of the control group (P 0.01). The length of the patellar tendon in the affected side was longer than that in the normal side after 6 months. The length of patellar tendon in the affected side decreased significantly (P 0.01), the length of patellar tendon in the treatment group decreased significantly (P 0.05), while in the control group, the length of patellar tendon did not change significantly (P 0.05). The thickness of the superior patellar tendon in the affected side was higher than that in the normal side before the intervention, and after 6 months, the patellar tendon in the affected side was on the patellar tendon. In the treatment group, the thickness of the patellar tendon and the inferior thickness of the patellar tendon decreased significantly, while in the control group, the thickness of the inferior patellar tendon did not decrease significantly (P 0.053.The area of hypoechoic area was lower than that of the control group). 6 months later, there was no significant decrease in the thickness of the patellar tendon. The hypoechoic surface of patellar tendon decreased significantly in the treatment group, and the hypoechoic area of the patellar tendon in the control group decreased significantly. The calcification area of the treatment group was better than that of the control group. 6 months later, the calcification area of the treatment group was better than that of the control group. The area of patellar tendon calcification in the treatment group was significantly lower than that in the control group (P 0.01), while in the control group the area of the calcification of the patellar tendon was not significantly decreased. The blood flow signal in the treatment group was better than that in the control group. After the first treatment, the blood flow signal in the treatment group was better than that in the control group. The blood flow signal increased significantly (P 0.01). After 3 months and 6 months, the blood flow signal of the control group was significantly decreased. The blood flow signal of the control group was significantly decreased than that of the control group. Conclusion: 1. The shock wave and rest have a certain curative effect on patellar tendon disease. Shock wave therapy combined with rest is better than rest alone. Both shock wave therapy and rest can cause morphological changes of patellar tendon. Shock wave therapy combined with rest is superior to simple rest .3. shock wave treatment of patellar tendon disease has the function of both symptoms and symptoms. 4. Bone ultrasound can not only be used in the diagnosis and treatment of patellar tendon disease, but also can be used to evaluate the curative effect of patellar tendon disease.
【学位授予单位】：北京体育大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R873

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