Swaine Jillian M, Moe Andrew, Breidahl William, Bader Daniel L, Oomens Cees W J, Lester Leanne, O'Loughlin Edmond, Santamaria Nick, Stacey Michael C
Faculty of Health and Medical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia, 6009, Australia; Institute for Health Research, The University of Notre Dame Australia, 19 Mouat Street (PO Box 1225), Fremantle, Western Australia, 6959, Australia; Fiona Stanley Hospital, State Rehabilitation Service, Spinal Service, South Metropolitan Health Service Fiona Stanley Fremantle Hospitals Group, Locked Bag 100, Palmyra DC, Western Australia, 6961, Australia.
Faculty of Health and Medical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia, 6009, Australia; Fiona Stanley Hospital, South Metropolitan Health Service Fiona Stanley Fremantle Hospitals Group, Locked Bag 100, Palmyra DC, Western Australia, 6961, Australia.
J Tissue Viability. 2018 Feb;27(1):32-41. doi: 10.1016/j.jtv.2017.07.004. Epub 2017 Aug 1.
High strain in soft tissues that overly bony prominences are considered a risk factor for pressure ulcers (PUs) following spinal cord impairment (SCI) and have been computed using Finite Element methods (FEM). The aim of this study was to translate a MRI protocol into ultrasound (US) and determine between-operator reliability of expert sonographers measuring diameter of the inferior curvature of the ischial tuberosity (IT) and the thickness of the overlying soft tissue layers on able-bodied (AB) and SCI using real-time ultrasound.
Part 1: Fourteen AB participants with a mean age of 36.7 ± 12.09 years with 7 males and 7 females had their 3 soft tissue layers in loaded and unloaded sitting measured independently by 2 sonographers: tendon/muscle, skin/fat and total soft tissue and the diameter of the IT in its short and long axis. Part 2: Nineteen participants with SCI were screened, three were excluded due to abnormal skin signs, and eight participants (42%) were excluded for abnormal US signs with normal skin. Eight SCI participants with a mean age of 31.6 ± 13.6 years and all male with 4 paraplegics and 4 tetraplegics were measured by the same sonographers for skin, fat, tendon, muscle and total. Skin/fat and tendon/muscle were computed.
AB between-operator reliability was good (ICC = 0.81-0.90) for 3 soft tissues layers in unloaded and loaded sitting and poor for both IT short and long axis (ICC = -0.028 and -0.01). SCI between-operator reliability was good in unloaded and loaded for total, muscle, fat, skin/fat, tendon/muscle (ICC = 0.75-0.97) and poor for tendon (ICC = 0.26 unloaded and ICC = -0.71 loaded) and skin (ICC = 0.37 unloaded and ICC = 0.10).
A MRI protocol was successfully adapted for a reliable 3 soft tissue layer model and could be used in a 2-D FEM model designed to estimate soft tissue strain as a novel risk factor for the development of a PU.
过度覆盖骨性突出的软组织中的高应变被认为是脊髓损伤（SCI）后发生压疮（PU）的一个危险因素，并且已经使用有限元方法（FEM）进行了计算。本研究的目的是将一种磁共振成像（MRI）方案转化为超声（US），并确定专业超声检查人员在使用实时超声测量健全个体（AB）和脊髓损伤患者坐骨结节（IT）下曲率直径及覆盖其上的软组织层厚度时的操作者间可靠性。
第一部分：14名平均年龄为36.7±12.09岁的健全个体参与者（7名男性和7名女性），由2名超声检查人员独立测量其在坐位加载和未加载时的3层软组织：肌腱/肌肉、皮肤/脂肪和总软组织，以及坐骨结节短轴和长轴的直径。第二部分：对19名脊髓损伤参与者进行筛查，3名因皮肤体征异常被排除，8名（42%）因皮肤正常但超声体征异常被排除。8名平均年龄为31.6±13.6岁的脊髓损伤参与者（均为男性，4名截瘫患者和4名四肢瘫患者）由相同的超声检查人员测量皮肤、脂肪、肌腱、肌肉和总体情况。计算皮肤/脂肪和肌腱/肌肉情况。
对于健全个体，在坐位加载和未加载时，3层软组织的操作者间可靠性良好（组内相关系数ICC = 0.81 - 0.90），而坐骨结节短轴和长轴的可靠性较差（ICC = -0.028和 -0.01）。对于脊髓损伤患者，在坐位加载和未加载时，总体、肌肉、脂肪、皮肤/脂肪、肌腱/肌肉的操作者间可靠性良好（ICC = 0.75 - 0.97），肌腱的可靠性较差（未加载时ICC = 0.26，加载时ICC = -0.71），皮肤的可靠性也较差（未加载时ICC = 0.37，加载时ICC = 0.10）。
一种MRI方案成功地适用于一个可靠的3层软组织模型，并且可用于二维有限元模型，该模型旨在估计软组织应变，作为压疮发生的一种新的危险因素。
