髕骨韌帶炎的超音波檢查

Ultrasonographic Examination of Patellar Tendinitis

髕骨韌帶炎是造成膝部疼痛的常見因之一，然而，過去對於髕骨韌帶炎的診斷的一直缺乏客觀的證據。本研究利用10MHz 高頻率超音波線性探頭來檢查臨床上臆斷為髕骨韌帶炎之髕骨韌帶，以觀察其病理變化，作為診斷及治療之參考。研究方法是採回溯性病歷研究，蒐集民國86年1月至86年12月接受髕骨韌帶超音波檢查患者34人，其中3位為雙側患病，共得37例。正常的髕骨韌帶在超音波下為一聯結髕骨下緣與脛骨上緣之低至中回音，均質且具平行排列纖維結構之構造。而依據異常回音訊號出現的情形，髕骨韌帶炎的超音波圖像可分為四類。第一類在髕骨附著端出現異常低回音區，共21例(60%)。第二類為在脛骨附著端出現異常低回音區，共10例(28.6%)。第三類為異常低回音訊號延伸至整條韌帶，共3例(8.6%)。第四類為出現異常的高回音訊號且具acoustic shadow，共1例(2.9%)。本研究同時測量各髕骨韌帶的上、中、下三處的厚度，結果顯示，健側的平均厚度分別為0.45cm、0.38cm、0.42cm；患側之平均厚度分別為0.61cm、0.47cm、0.52cm。其中上、下二附著厚度在兩側之差異具有統計上意義(paired t-test：p=0.007，p=0.041)。由本研究中得知，軟組織超音波可清楚顯示髕骨韌帶炎之結構異常，對於其診斷與治療追蹤有相當大的助益。

Patellar tendinitis is a common cause of knee pain, but objective evidence for the diagnosis was usually absent in the past. In this retrospective study, we reviewed sonograms of patellar tendons in 34 patients who had been diagnosed with patellar tendinitis clinically. A 10 MHz linear array ultrasound transducer was used to perform the examination. A normal patellar tendon appears sonographically as a homogeneous, slightly hypoechoic linear structure with parallel arranged hyperechoic striae. Four different sonographic types of patellar tendinitis could be found in our study. Type 1 had an abonormal hypoechoic sjadow in the proximal patellar tendon near its patellar origin (21 tendons, 60%). An abnormal hypoechoic shadow in the distal patellar tendon near its tibial insertion was defined as type 2 (10 tendons, 28.6%). Type 3 had an extended abnormal hypoechoic shadow throughout the whole length of the patellar tendon (3 tendons, 8.6%). Abnormal hyperechoic spots with acoustic shadow in the patellar tendon was classified as type 4 (1 tendon, 2.9%). The average thicknesses of the patellar tendon at the upper, middle and lower portions on the asymptomatic side were 0.45cm, 0.38cm and 0.42cm respectively; compared to 0.61cm, 0.47cm and 0.52cm on the symptomatic side. The difference of patellar tendon thickness was statistically significant at the upper and lower portions (paired t-test, p=0.007, p=0.041). we conclude that ultrasonography is useful in the diagnosis and follow up of patellar tendinitis.