超声在跖腱膜炎诊断中的价值

目的　探讨超声测量在跖腱膜炎诊断中的价值。方法　应用超声观察和测量临床诊断为跖腱膜炎并经手术治疗证实的 46例患者的双侧跖腱膜 ,并测量 2 8例正常中年人的双侧跖腱膜作为对照。结果　患者组患侧足的跖腱膜其跟骨附着部的厚度 [(5 .7± 1.0 )mm ]较其健侧的厚度 [(3 .4± 0 .4)mm ] ,明显增加 (P <0 .0 0 1) ,亦较对照组的厚度 [(2 .9± 0 .2 )mm]明显增加 (P <0 .0 0 1)。结论　超声测量对跖腱膜炎具有明确诊断价值 ,且具有无创、便捷、价格低廉的优点     

超声引导下介入治疗跖筋膜炎的临床价值

目的探讨超声引导下介入治疗跖筋膜炎的临床价值。方法 2011年8月至2014年8月在四川省人民医院经临床及超声诊断而保守治疗效果不佳的38例跖筋膜炎患者,采用随机数字表法将38例患者随机分为试验组和对照组,试验组进行超声引导下介入治疗,对照组进行传统封闭治疗,分别于注射类固醇激素治疗前、治疗后4周和12周行足底疼痛评分(采用视觉模拟评分法,VAS评分)和超声检查,并进行对比分析。结果 2组患者治疗后VAS评分及跖筋膜厚度均较治疗前明显改善(P均<0.01)。治疗后4周,试验组VAS评分及跖筋膜厚度与对照组比较,差异均无统计学意义[2.52±0.77 vs 2.68±0.82,P>0.05;(4.56±0.25)mm vs(4.72±0.38)mm,P>0.05]。治疗后12周,试验组VAS评分较对照组降低,差异有统计学意义(1.47±0.77 vs 2.37±0.68,P<0.01);试验组跖筋膜厚度较对照组变薄,差异有统计学意义[(4.02±0.24)mm vs(4.53±0.35)mm,P<0.01]。治疗后12周,试验组跖筋膜内钙化灶较治疗前消失或减少。结论超声引导下介入治疗跖筋膜炎较传统封闭治疗更准确有效,具有重要的临床价值。     

超声弹性成像评价跖腱膜炎介入治疗效果

跖腱膜炎是导致足底尤其足根部疼痛最常见的原因。近年来随着人口老龄化加快及人们体育运动的不断增加,足底筋膜炎的患者越来越多。对跖腱膜炎的治疗主要采用皮质类固醇激素患处局部注射,既往对其临床疗效的观察主要通过视觉模拟量表(VAS)评分来评估,但常因患者对疼痛程度的理解差异而导致评分误差。近年来,超声引导下介入治疗并运用超声新技术评估治疗效果的研究已在临床开展。本组应用超声弹性成像评价超声引导下跖腱膜炎药物注射后的治疗效果,旨在探讨超声弹性成像在跖腱膜炎诊治中的临床应用价值。     

超声引导下针刺触发点治疗足底筋膜炎

目的 观察超声引导下针刺触发点治疗足底筋膜炎的临床效果。方法 选取48例足底筋膜炎患者，并随机分为2组，对单纯组（n=24）采用单纯非负重跖腱膜拉伸训练，联合组（n=24）采用超声引导下针刺触发点结合非负重跖腱膜拉伸训练；分别于治疗前（T₀）及治疗后1个月（T₁）、3个月（T₂）对患者进行"第1步"数字疼痛评分（NPRS）、美国矫形外科足踝协会踝-后足功能评分（AOFAS）以及36条目健康调查量表中生理（PCS）和心理（MCS）评分。结果 治疗前后2组NPRS、AOFAS、PCS和MCS评分总体差异均有统计学意义（P均<0.01），治疗后均较治疗前改善。联合组T₁和T₂的NPRS均低于单纯组（P均<0.01），T₁和T₂的AOFAS、PCS评分均高于单纯组（P均<0.05），而2组间T₁和T₂的MCS评分差异均无统计学意义（P均>0.05）。结论 超声引导下针刺触发点联合拉伸训练和单纯非负重跖腱膜拉伸训练对于足底筋膜炎均有效，前者缓解疼痛和改善足踝功能效果更佳。     

实时B超引导下经皮跖腱膜切断术：尸体足标本研究

目的探讨实时Ｂ超引导下经皮跖腱膜切断术治疗跖腱膜炎／跟骨骨刺综合症的可行性。方法在实时Ｂ超引导下对８只新鲜尸体足标本进行经皮跖腱膜切断术。术后行解剖观察。结果通过解剖观察发现所有标本中跖腱膜均按预定的设想被完全切断。跖腱膜深面的趾短屈肌损伤深度小于２ｍｍ,其余肌肉及足底内外侧动、静脉和神经均无损伤。结论这一新术式具有操作简便、安全准确、组织损伤小、可重复性好等优点,可进行临床实际应用     

结节性筋膜炎的组织病理学分型及其超声表现

目的 分析结节性筋膜炎的组织病理学分型及其相应二维及彩色多普勒超声声像图特征,探讨超声诊断结节性筋膜炎的价值。 方法 分析27例经手术病理证实的结节性筋膜炎患者的二维和彩色多普勒超声声像图特征及与其组织病理学分型的相关性。 结果 结节性筋膜炎超声声像图表现多样,共有特征为皮下或肌层内弱回声团块,病变多数小于3 cm。不同组织病理学分型的超声表现具有一定特征。按照病变部位可分为皮下型、筋膜型及肌内型,其中皮下型多与深筋膜关系密切;筋膜型具有特征性的沿浅筋膜和皮下脂肪小叶的纤维间隔伸展,呈"星状"突起的超声表现。根据病变结构不同可分为黏液型、细胞型和纤维型,黏液型团块内部可有小片状无回声区,边缘有血流;细胞型团块内部及边缘有血流,且边缘血流明显,而纤维型无明显血流。 结论 不同分型结节性筋膜炎具有一定特征;二维及彩色多普勒超声可作为结节性筋膜炎诊断的重要辅助检查。     

不同跖趾关节角度下冲击波联合肌内效贴治疗足底筋膜炎的疗效观察

目的探讨不同跖趾关节角度下体外冲击波(ESWT)联合肌内效贴治疗足底筋膜炎的临床疗效。方法采用随机数字表法将63例足底筋膜炎患者分为对照组、治疗A组及治疗B组, 每组21例。3组患者均给予肌内效贴常规干预, 治疗A组、治疗B组分别于跖趾关节休息位、最大背伸位行ESWT治疗。于治疗前、治疗3周后及1个月后随访时分别采用视觉模拟评分法(VAS)、肌肉骨骼超声、星偏移平衡测试(SEBT)对3组患者疼痛程度(晨起后开始步行时)、足底筋膜厚度及平衡能力进行评价。结果治疗前3组患者疼痛VAS评分、足底筋膜厚度及SEBT测试各方向结果组间差异均无统计学意义(P>0.05)。治疗3周后及1个月后随访时3组患者疼痛VAS评分、足底筋膜厚度及SEBT测试各方向结果均较治疗前明显改善(P<0.05);进一步比较发现, 治疗A组及治疗B组上述各项指标改善幅度均显著优于对照组水平(P<0.05), 且治疗B组除SEBT测试左侧、右侧平均距离与治疗A组差异无统计学意义(P>0.05)外, 其他各项疗效指标均显著优于治疗A组水平(P<0.05)。结论在肌内效贴基础上辅以ESWT治疗能更...     

早期类风湿关节炎跖趾关节滑膜炎的临床检查与超声检查比较

目的应用高频彩色多普勒超声检查早期类风湿关节炎(RA)患者的跖趾关节,调查跖趾关节滑膜炎在早期RA中的发病率及病变特点,并与临床检查结果相比较。方法对连续57例病史<1年的RA患者在入院当天进行跖趾关节体格检查,记录关节有无肿胀、触痛,前足挤压试验阳性情况。同日进行跖趾关节的超声检查,记录关节积液、滑膜增生、滑膜血流情况。以超声检查结果作为金标准,对跖趾关节的体格检查及超声检查结果进行一对一比较。结果 29例患者主诉有足趾痛和(或)行走时前脚掌疼痛症状(占50.9%)。体格检查发现85个跖趾关节肿/痛阳性(阳性率14.9%),45只足前足挤压试验阳性(阳性率39.5%)。对照组超声检查未发现有跖趾关节滑膜炎。RA组中有45例患者(占78.9%)超声检查发现87只足至少1个跖趾关节有滑膜炎。全部570个跖趾关节中共287个发现有滑膜炎(阳性率50.4%),以第2跖趾关节滑膜炎阳性率最高,其次为第3跖趾关节。23个关节增生的滑膜内可检测到血流信号(占有滑膜增生关节的9.8%)。查体肿/痛关节阳性诊断跖趾关节滑膜炎与超声检查诊断滑膜炎的Kappa值为0.134,二者一致性较低。以超声检查结果为金标准,关节肿/痛、挤压试验检测跖趾关节滑膜炎的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为0.22、0.92、0.73、0.54、2.66、0.85和0.51、0.96、0.98、0.38、13.66、0.51。结论跖趾关节是早期RA较易累及的关节,临床检查虽有较高的特异性,但不够敏感,超声在检测跖趾关节滑膜炎中有较高的应用价值。     

超声引导下糖皮质激素注射治疗单侧慢性跖筋膜炎的临床疗效观察

目的探讨超声引导下注射糖皮质激素治疗单侧慢性跖筋膜炎的临床疗效。方法采用前瞻性研究方法,选取2019年1～10月首都医科大学附属北京友谊医院收治的单侧慢性跖筋膜炎患者63例,按照随机数字表法将患者分为对照组、压痛点注射组和超声引导下注射组,每组各21例。对照组患者使用发散式体外冲击波治疗跖筋膜炎,每3 d接受一次治疗,一共治疗5次;压痛点注射组在压痛点注射倍他米松注射液1 ml和利多卡因1 ml;超声引导下注射组在超声引导下将倍他米松注射液1 ml和利多卡因1 ml注射到跖筋膜深层。所有患者门诊随访12周。记录治疗前和末次随访时患者足部疼痛的视觉模拟评分(VAS)和足踝关节功能的美国足踝矫形协会(AOFAS)评分、末次随访患者的治疗有效率以及患者对治疗效果满意度,并进行比较。结果所有患者均得到完整随访。末次随访时对照组、超声引导下注射组和压痛点注射组的VAS分别是:4. 2±0. 4分、3. 2±0. 4分和4. 0±0. 5分,而三组AOFAS分别为48. 5±4. 7分、74. 6±7. 5分和49. 4±5. 2分。三组患者末次随访VAS评分均较治疗前显著下降,差异具有统计学意义(P 0. 05)。超声引导下注射组VAS明显低于其他两组,差异具有统计学意义(P 0. 05)。超声引导下注射组AOFAS评分明显高于其他两组,差异具有统计学意义(P 0. 05)。而压痛点注射组和对照组AOFAS评分在治疗前后差异无统计学意义(P0. 05)。末次随访治疗有效率和患者满意度方面,超声引导下注射组明显高于压痛点注射组和对照组,差异具有统计学意义(P 0. 05)。结论超声引导下注射糖皮质激素能够减轻单侧慢性跖筋膜炎疼痛,并且改善足踝功能,是治疗单侧慢性跖筋膜炎有效的非手术方法。     

Plantar fibromatosis: most common sonographic appearance and variations.

PURPOSE: The aim of this study was to describe the most common sonographic appearances of plantar fibromatosis, thus enabling sonographic diagnosis of this benign, focally invasive fibrous neoplasm. METHODS: The medical records, pathologic reports, and sonographic reports and images of 22 patients with palpable plantar masses were reviewed retrospectively. The sonographic findings were used to characterize those masses with respect to location, shape, size, and echogenicity. Sixteen patients were included in this study because of the proximity of their lesions to the plantar fascia; 6 patients were excluded because their lesions were metatarsophalangeal bursae or ganglia. RESULTS: The 20 feet examined in the 16 patients studied contained 43 distinct lesions, all located on the surface of the plantar fascia. Thirty-seven (86%) of the 43 were 20 mm long or less. Thirty-seven (86%) of the 43 lesions were elongated; the remaining 6 (14%) were round or oval. Twenty-five (68%) of the 37 elongated lesions had tapered ends, and the other 12 (32%) had rounded ends. Thirty-one (72%) of the 43 lesions were hypoechoic; 25 (81%) of these 31 measured as long as 10 mm. Ten (83%) of the 12 lesions that had mixed echogenicity were longer than 10 mm. CONCLUSIONS: The lesions of plantar fibromatosis were characteristically located on the surface of the plantar fascia, sagittally elongated, most often less than 20 mm long, fusiform, and hypoechoic. Lesions longer than 10 mm often exhibited mixed echogenicity. The superficial location and appearance should strongly suggest plantar fibromatosis, although careful examination is required to exclude other possibilities, such as sarcoma.     

Serial ultrasonographic findings of plantar fasciitis after treatment with botulinum toxin a: a case study

Chou L-W, Hong C-Z, Wu E-S, Hsueh W-H, Kao M-J. Serial ultrasonographic findings of plantar fasciitis after treatment with botulinum toxin A: a case study.Plantar fasciitis is a common cause of heel pain and is the result of a degenerative process of the plantar fascia at its calcaneal attachment. A case study of a preliminary experience with local injections of botulinum toxin A (BTX-A) for the treatment of chronic plantar fasciitis in a 43-year-old woman is presented. We injected the patient with 70 units of BTX-A (0.7mL) in 2 divided doses: 40 units (0.4mL) in the tender region of the heel, and 30 units (0.3mL) in the most tender point of the foot arch. Visual analog scale (VAS) and pressure pain threshold (PPT) were measured to evaluate the efficacy of BTX-A injections. Real-time, high-resolution ultrasonographic findings of the plantar fascia after BTX-A injections were also used for serial follow-ups. After BTX-A injection, decreased VAS values were reported and increased PPT was observed. In ultrasonographic studies, the thickness of the plantar fascia and the hypoechogenicity of the fascia were reduced. Decreased plantar fascia thickness was observed on the first and third week after BTX-A injections. The findings were compatible with the changes in pain assessed by VAS and PPT. Ultrasonographic findings also indicated a progressive decrease in the thickness of the underlying muscle belly. Ultrasonography seems to be a valuable, noninvasive diagnostic tool for the evaluation of plantar fasciitis treated with BTX-A injections. It can offer objective measurements of therapeutic effects and is feasible for serial follow-ups.     

乳腺小肿物超声特征的Logistic回归分析

目的探讨乳腺小肿物的超声征象,应用Logistic回归分析评价其应用价值。方法回顾性分析经手术病理证实的497个乳腺小肿物的超声征象,根据病理结果分为良性组466个和恶性组31个,比较两组超声特征的差异。应用多因素二元Logistic回归分析筛选出鉴别诊断乳腺小肿物良恶性的独立影响因素,建立回归方程,绘制受试者工作特征(ROC)曲线分析Logistic回归模型的预测价值。结果两组超声特征中形态、纵横比、边缘、回声类型、肿物内钙化、周围组织相关征象及肿物内血流信号比较差异均有统计学意义(均P<0.05),两组肿物后方回声特征比较差异无统计学意义(P=0.26)。多因素二元Logistic回归分析显示纵横比≥1、内部血流信号、边缘血流信号均是鉴别乳腺小肿物良恶性的独立影响因素(OR=9.56、9.68、4.29,P=0.02、0.00、0.04);Logistic回归方程为:Logistic(P)=-3.86+2.23×纵横比≥1+2.29×内部血流信号+1.46×边缘血流信号。Logistic回归模型以预测概率P=0.50作为阈值,鉴别小肿物良恶性的准确率95.2%,敏感性83.9%,特异性89.1%,ROC曲线下面积0.89。结论以纵横比和血流信号建立的Logistic回归模型有助于乳腺小肿物良恶性的鉴别诊断。     

胎儿半椎体的产前超声诊断

目的 探讨产前超声对胎儿半椎体的诊断价值.方法 回顾分析我院诊断的3例胎儿半椎体病例的产前二维及三维超声表现,并与产后超声检查、其他影像学检查及病理结果进行对照.结果 3例胎儿超声检查均可见脊柱形态改变,受累节段仅有一半的椎体.其中1例经出生后影像学证实,1例经尸检病理证实,1例尚在随访中.结论 胎儿半椎体具有特征性超声表现,不合并其他畸形时多数预后良好,仔细的中孕期超声检查有助于早期发现病变并给予适当的遗传咨询.

Abstract：

Objective To investigate the diagnostic value of prenatal ultrasonography in the fetal hemivertebra. Methods The ultrasonographic findings of three fetuses with hemivertebra diagnosed in our hospital were reviewed and compared with those of postnatal ultrasonography,other image modalities,and autopsy. Results In all fetuses,a distortion of the spine was observed where only one half of the vertebra could be identified. The parents opted for termination of the pregnancy in one case and the deformity was confirmed by autopsy. The other two fetuses were delivered and in one fetus the diagnosis was confirmed by radiological assessment. Conclusions Hemivertebra can be diagnosed accurately by second-trimester ultrasonography. The prognosis is mostly favorable when no other anomalies are associated. Meticulous examination may disclose the lesion and help decide the fate of pregnancy.     

Effectiveness of Prefabricated and Customized Foot Orthoses Made From Low-Cost Foam for Noncomplicated Plantar Fasciitis: A Randomized Controlled Trial

Baldassin V, Gomes CR, Beraldo PS. Effectiveness of prefabricated and customized foot orthoses made from low-cost foam for noncomplicated plantar fasciitis: a randomized controlled trial.

Objectives

To evaluate the effectiveness of prefabricated and customized foot orthoses made from low-cost foam (ethylene vinyl acetate [EVA]) in plantar fasciitis.

Design

Double-blinded randomized controlled trial.

Setting

Public rehabilitation referral medical center.

Participants

One hundred forty-two adults (75% women) with plantar fasciitis, without anatomical alterations in the feet. Seventeen subjects (12%) were lost during the follow-up.

Interventions

Prefabricated and customized foot orthoses, both made from EVA, used for 8 weeks.

Main Outcome Measures

The primary outcome was pain (modified subscale of the Foot Function Index, [FFI] pain). The secondary outcomes were pain elicited by palpation in the medial calcaneal tuberosity and modified FFI total. Each participant was reviewed in the 4th and 8th weeks of follow-up.

Results

One hundred twenty-five participants returned to at least 1 of the follow-up evaluations (63 in the prefabricated and 62 in the customized groups). There was a significant improvement in both groups (P<.05), but there was no difference of modified FFI pain between intragroup differences at 4 (4.03 points; 95% confidence interval [CI], −4.2 to 12.3) and 8 weeks (3.93 points; 95% CI, −4.6 to 12.5).

Conclusions

The low-cost prefabricated and customized foot orthoses, as used in this trial, had similar effectiveness in the treatment of noncomplicated plantar fasciitis after 8 weeks of use. Our results were similar to other trials, although those trials did not use orthoses made from EVA. Thus, EVA prefabricated inserts may be the best choice for the treatment of plantar fasciitis without complication.     

41例异位妊娠声像图分析及超声诊断价值探讨

目的 探讨异位妊娠的超声表现及超声诊断价值。方法 对我院近四年来经B超检查、保守治疗或手术及病理检查证实的41例异位妊娠声像图表现作回顾性分析。结果 胎囊型7例（占17．07％）;宫旁非特异性包块21例（占51．22％）;盆腔、腹腔积液36例（占87．8％）;手术病例的超声诊断符合率88．2％（30／34）。结论 B超诊断异位妊娠准确性较高,可作为首选的辅助诊断方法;充分掌握异位妊娠的各种超声表现、鉴别诊断要点和临床诊断依据,可以提高B超诊断率。