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利用超声弹性成像技术测定糖尿病患者截肢下肢不同跟骨结构中透明质酸的增强效果。

Determination of the augmentation effects of hyaluronic acid on different heel structures in amputated lower limbs of diabetic patients using ultrasound elastography.

机构信息

Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan.

出版信息

Ultrasound Med Biol. 2012 Jun;38(6):943-52. doi: 10.1016/j.ultrasmedbio.2012.02.031. Epub 2012 Apr 12.

Abstract

This study measured tissue properties of different anatomies of heels in amputated lower limbs of diabetic patients before and after hyaluronic acid (HA) or normal saline (NS) injections. Seven amputated lower limbs from six diabetic patients constituted the experimental group and one amputated lower limb from a diabetic patient served as the control. The limbs were placed in a fixation platform. A 5-12 MHz linear-array ultrasound transducer controlled by a stepping motor was used to load and unload tested heels. The loading-unloading velocity was 6 mm/s and the maximum loading stress was 178 kPa. Loading-unloading tests were performed before and after 1 mL HA injections into heels in the experimental group. The control limb underwent the same test before and after 1 mL NS injection. The unloaded thickness and Young's modulus of the macrochambers, microchambers and heel pads were determined before and after the interventions. The unloaded thickness of the macrochambers and the heel pad increased significantly (p = 0.012) after HA injection. The Young's modulus of the macrochambers decreased nonsignificantly after HA injections. Similar thickness and tissue stiffness changes were observed in the control limb. The baseline heel-pad energy dissipation ratio (EDR(hp)) was 81.3 ± 1.3% and decreased significantly (p = 0.012) to 73.1 ± 1.7% after HA injections. The EDR(hp) in the control increased after NS injection. Histologic examinations revealed localized HA accumulation in the macrochambers with an extension into the adjacent fibrous septa. Injection of HA can increase tissue thickness and enhance heel-pad tissue resilience.

摘要

本研究测量了糖尿病患者截肢下肢中不同足跟解剖结构在注射透明质酸(HA)或生理盐水(NS)前后的组织特性。实验组成员由 6 名糖尿病患者的 7 条截肢下肢组成,对照组为 1 名糖尿病患者的 1 条截肢下肢。将下肢放置在固定平台上。使用由步进电机控制的 5-12MHz 线性阵列超声换能器对测试足跟进行加载和卸载。加载-卸载速度为 6mm/s,最大加载应力为 178kPa。实验组在对足跟注射 1mlHA 前后进行加载-卸载试验,对照组在对足跟注射 1mlNS 前后进行相同的测试。干预前后确定了宏观室、微观室和足跟垫的空载厚度和杨氏模量。HA 注射后,宏观室和足跟垫的空载厚度明显增加(p=0.012)。HA 注射后,宏观室的杨氏模量无明显变化。对照组也观察到类似的厚度和组织硬度变化。基线足跟垫能量耗散比(EDR(hp))为 81.3±1.3%,HA 注射后显著降低(p=0.012)至 73.1±1.7%。NS 注射后,对照组的 EDR(hp)增加。组织学检查显示 HA 局部积聚在宏观室中,并延伸到相邻的纤维隔中。HA 注射可以增加组织厚度并增强足跟垫组织的弹性。

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