本文選題：沖擊波　切入點：髕腱腱病　出處：《北京體育大學》2015年博士論文　論文類型：學位論文

【摘要】：目的：本研究通過觀察沖擊波治療髕腱腱病的療效和超聲影像變化,驗證沖擊波治療髕腱腱病是否能夠消除癥狀、改善功能和促進髕腱組織重新修復,從宏觀上探討沖擊波治療髕腱腱病的作用原理,以及肌骨超聲在髕腱腱病診斷、治療定位和療效評估中的運用。方法：髕腱腱病患者65例,隨機分為治療組33例和對照組32例,治療組予放射狀沖擊波治療,每周1次,共治療5次。對照組予休息干預。通過VAS、VISA、Lysholm、2000IKDC評分觀察癥狀和功能的變化,采用肌骨超聲觀察髕腱組織結(jié)構(gòu)影像學變化,進行9個月連續(xù)跟蹤隨訪。結(jié)果：1.VAS評分：9個月后,治療組和對照組VAS評分均顯著降低(P0.05),治療組優(yōu)于對照組(P0.05)。2. VISA、Lysholm、2000 IKDC評分：9個月后,治療組和對照組評分均顯著升高(P0.01),治療組優(yōu)于對照組(P0.01)。3.超聲評估：①髕腱長度。干預前患側(cè)髕腱長度長于健側(cè)(P0.05),6個月后,患側(cè)髕腱長度顯著降低(P0.01),治療組髕腱長度顯著降低(P0.05),對照組髕腱長度變化不明顯(P0.05)。②髕腱厚度。干預前患側(cè)髕腱上、下厚度均高于健側(cè)(P0.05),6個月后,患側(cè)髕腱上、下厚度顯著降低(P0.05),治療組髕腱上、下厚度顯著降低(P0.05),對照組髕腱上、下厚度降低不明顯(P0.05)。③低回聲面積。6個月后,治療組髕腱低回聲面顯著降低(P0.01),對照組髕腱低回聲面積顯著降低(P0.05),治療組優(yōu)于對照組(P0.01)。④鈣化面積。6個月后,治療組髕腱鈣化面積顯著降低(P0.01),對照組髕腱鈣化面積降低不明顯(P0.05),治療組優(yōu)于對照組(P0.05)。⑤血流信號。治療組第1次治療后,血流信號顯著增加(P0.01),3個月、6個月后血流信號顯著減少(P0.01),對照組血流信號顯著減少(P0.05),治療組優(yōu)于對照組(P0.01)。結(jié)論：1.沖擊波和休息對髕腱腱病均有一定的療效,沖擊波治療配合休息優(yōu)于單純休息。2.沖擊波治療和休息均能引起髕腱組織形態(tài)學的變化,沖擊波治療配合休息優(yōu)于單純休息。3.沖擊波治療髕腱腱病具有標本兼治的作用。4.肌骨超聲不僅可以用于髕腱腱病的診斷和治療定位,還可以用于髕腱腱病的療效評估。
[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.
【學位授予單位】：北京體育大學
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R873

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