超声弹性成像技术在脑卒中后痉挛性偏瘫患者康复疗效评估中的应用

Application of ultrasound elastography in evaluating clinical efficacy of rehabilitation in spastic hemiplegia patients after stroke

目的探讨超声弹性成像技术用于评估脑卒中后痉挛性偏瘫患者康复疗效的意义。方法选取脑卒中后下肢痉挛性偏瘫患者25例(观察组)及健康人25名(对照组)为研究对象。观察组行常规康复治疗,于治疗前与治疗4周后采用改良Ashworth评分、临床痉挛指数(CSI)、下肢简式Fugl-Meyer运动量表(FMA)进行下肢功能评定,同时以剪切波超声弹性成像技术检测对照组及观察组治疗前后下肢股外侧肌、股内侧肌、股直肌及股二头肌的硬度,记录组织弹性图,比较杨氏模量值,对2组结果进行统计分析。结果观察组治疗后改良Ashworth评分及CSI均较治疗前下降(P<0.05),下肢FMA评分较治疗前高(P<0.01);治疗前观察组患侧与正常对照组相应一侧下肢相关肌肉的杨氏模量值比较差异均有统计学意义(P均<0.01),观察组治疗后患侧股外侧肌、股内侧肌、股直肌及股二头肌杨氏模量值均低于治疗前(P均<0.05),但与对照组比较差异仍有统计学意义(P均<0.01)。结论超声弹性成像技术有助于评估脑卒中后痉挛性偏瘫患者痉挛下肢肌张力的变化。

Objective To evaluate the significance of ultrasound elastography in the evaluation of clinical efficacy of rehabilitation in spastic hemiplegia patients after stroke. Methods Twenty five patients with spastic hemiplegia in the lower limb after stroke were assigned into the observation group, and 25 healthy counterparts were allocated into the control group. In the observation group, conventional rehabilitation treatment was delivered. The lower limb function was assessed by the modified Ashworth scale, clinical spasm index （CSI） and simplified Fugl-Meyer assessment （FMA） of lower limb before and 4 weeks after therapy. The changes in the hardness of musculus vastus lateralis of the lower limb, vastus medialis, rectus femoris and biceps muscle of thigh before and after treatment between two groups were detected by shear-wave ultrasound elastography. The tissue elasticity mapping was recorded. The Young＇s modulus value was statistically compared between the observation and control groups. Results In the observation group, the modified score and CSI were significantly decreased （both P 〈 0.05）, whereas the FMA score of the lower limb was considerably increased after therapy （both P 〈 0.01）. Prior to treatment, the Young＇s modulus values in the affected side of patients from the observation group significantly differed from those of the corresponding side in their counterparts from the control group （all P 〈 0.01）. After treatment, the Young＇s modulus values of the musculus vastus lateralis of affected side, vastus medialis, rectus femoris and biceps muscle of thigh were significantly decreased in the observation group （all P 〈 0.05）, which still significantly differed from those in the control group （all P 〈 0.01）. Conclusion Ultrasound elastography can be utilized to evaluate the changes of lower limb muscle tension in spastic hemiplegia patients after stroke.