| 摘要: |
| 目的：评估剪切波弹性成像(SWE)在不同肩关节体位测量冻结肩喙肱韧带硬度的可重复性。方法 两名有SWE工作经验的超声医师对45名冻结肩Ⅱ、Ⅲ期患者的喙肱韧带进行SWE检查并测量平均弹性模量即为喙肱韧带硬度,第2次测量在首次测量后1周进行。喙肱韧带的SWE测量体位采用肩关节中立位、外旋10°、外旋20°、外旋30°进行,使用组内相关系数(ICC)的双向随机模型分析4种肩关节体位测量的喙肱韧带硬度的检查者内及检查者间可重复性,Shapiro-Wilk检验检查者间及检查者内测量差值的正态分布,测量的差值符合正态分布绘制Bland-Altman图分析检查者间及检查者内平均差异的95%CI一致性限制。结果 当肩关节中立位、外旋10°、外旋20°时,检查者组内及组间测量的喙肱韧带硬度有统计学差异(P＜0.05)；检查者组内及组间测量的喙肱韧带硬度可重复性差,ICC均＜0.40。当肩关节外旋30°时,检查者组内及组间测量的喙肱韧带硬度的差异无统计学意义(P＜0.05),检查者组内及组间测量的喙肱韧带硬度的可重复性好：检查者A组内ICC为0.645(95% CI 0.439~0.788,P=0.000),检查者B组内ICC为0.619(95% CI 0.399~0.771,P=0.000)；两检查者组间第1次测量ICC为0.659(95% CI 0.458~0.797,P=0.000),第2次测量ICC为0.543(95% CI 0.297~0.721,P=0.000)。Shapiro-Wilk检验肩关节外旋30°时,检查者组内及组间测量喙肱韧带硬度的差值服从正态分布。Bland-Altman散点图提示,肩关节外旋30°时,检查者A组内测值落在95%一致性界限(limits of agreement, LOA)内的点为98%,检查者B组内测值落在95%LOA内的点为93%；第一次组间测量落在95%LOA内的点为96%,第二次组间测量落在95%LOA内的点为98%；组内及组间测量的一致性较好。结论 SWE测量Ⅱ、Ⅲ期冻结肩患者喙肱韧带硬度时,采用肩关节外旋30°所测得的喙肱韧带硬度可重复性及检查者一致性较好。 |
| 关键词: 剪切波弹性成像 喙肱韧带 冻结肩 超声 可重复性 |
| DOI： |
| 投稿时间：2024-04-01修订日期：2024-08-25 |
| 基金项目:宝鸡市卫生健康委员会2023年科研计划立项课题(2023-053) |
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| Reproducibility of shear wave elastography for assessing stiffness of the frozen shoulder coracohumerale ligament |
| Zhang Jingfeng,Wan Yanping,Wang Wenjuan,Fan Youyi,Yan Yanni |
| (Department of Ultrasound Medicine,Baoji High-Tech Hospital) |
| Abstract: |
| Objective To assess the reproducibility of shear wave elastography (SWE) in measuring the stiffness of the frozen shoulder coracohumeral ligament in different shoulder positions. Methods Two experienced sonographers conducted SWE on the coracohumeral ligament to measure the mean elastic modulus, representing its stiffness, in 45 patients presenting with stages Ⅱ and Ⅲ of frozen shoulder. The second measurement was carried out one week following the initial assessment. SWE measurements were taken in the neutral shoulder position, as well as at 10°, 20°, and 30° of external rotation. The intra- and inter-examiner reproducibility of the coracohumeral ligament"s elasticity modulus in these four shoulder positions was assessed using a two-way randomized model with an intragroup correlation coefficient (ICC). The normal distribution of inter- and intra-examiner differences in measurements was tested using the Shapiro-Wilk test. Differences that followed a normal distribution were visualized on Bland-Altman plots to determine the 95% confidence interval (CI) limits of agreement for mean differences between and within examiners. Results There was a statistically significant difference in coracohumeral ligament stiffness measured within and between examiner groups when the shoulder was in neutral position, 10° and 20° of external rotation (P < 0.05); the reproducibility of coracohumeral ligament stiffness measured within and between examiner groups was poor, and the ICCs were both < 0.40. When the shoulder joint was externally rotated at 30°, the differences in coracohumeral ligament stiffness measured within and between groups were not statistically significant (P<0.05), and the reproducibility of coracohumeral ligament stiffness measured within and between groups was good: the ICC was 0.645 (95% CI 0.439~0.788, P=0.000) for examiner A, 0.619 (95% CI 0.399~0.771, P=0.000) for examiner B; and the ICC at first measurement between two examiners was 0.659 (95% CI 0.458~0.771). (95% CI 0.399 to 0.771, P=0.000); between the two examiner groups the ICC was 0.659 (95% CI 0.458 to 0.797, P=0.000) for the 1st measurement and 0.543 (95% CI 0.297 to 0.721, P=0.000) for the 2nd measurement. The initial ICC measurement between the two examiners was 0.659 (95% CI 0.458-0.797, P=0.000), and the subsequent ICC measurement was 0.543 (95% CI 0.297-0.721, P=0.000). Furthermore, the Shapiro-Wilk test for differences in intra- and intergroup measurements of the examiner"s group at 30° of external rotation of the shoulder follows a normal distribution. The Bland-Altman scatterplot suggested that at 30° of shoulder external rotation, 98% of the points within the 95% limits of agreement (LOA) fell within the 95% LOA for the intragroup measurements in Examiner Group A, and 93% for the intragroup measurements in Examiner Group B. The number of points that fell within the 95% LOA for the first between-group measurements was 96%, and the number of points that fell within the 95% LOA for the second between-group measurements was 98%; the consistency between the intra- and between-group measurements was good. Conclusion The SWE measures stiffness of the coracohumerale ligament in patients with stage Ⅱ and Ⅲ frozen shoulder, and values measured using 30° of external rotation of the shoulder joint have good repeatability and checking consistency. |
| Key words: Shear wave elastography coracohumerale ligament Frozen shoulder Ultrasound Reproducibility |
