声触诊组织量化技术对糖尿病患者小腿后侧肌群弹性的研究

Evaluation of shear wave velocity changes of the gastrocnemius and soleus muscles in diabetic patients using virtual touch tissue quantification

目的 应用声触诊组织量化(VTQ)技术研究糖尿病患者腓肠肌及比目鱼肌的剪切波速度变化。方法 应用VTQ技术选取2017年10月至2018年3月在温州医科大学附属第二医院确诊的35例糖尿病患者及22例健康人的小腿后侧肌群进行检测,分别于踝关节自然位、最大背屈位及最大跖屈位下在纵切获得双侧小腿腓肠肌内侧头、腓肠肌外侧头、比目鱼肌的剪切波速度。比较糖尿病组小腿后侧不同肌肉在踝关节同一体位下剪切波速度的差异,比较糖尿病组与正常对照组间同一体位下对应小腿肌肉的剪切波速度,同时分析小腿后侧不同肌肉在不同体位下获得剪切波速度的重测信度。结果 在踝关节自然位置、最大背屈位,最大跖屈位下,糖尿病组的左右侧小腿腓肠肌内侧头、腓肠肌外侧头及比目鱼肌的剪切波速度对应比较,差异无统计学意义(P> 0.05)。糖尿病组患者踝关节在同一体位下,腓肠肌内侧头与腓肠肌外侧头剪切波速度比较,差异无统计学意义(P> 0.01),腓肠肌内侧头与比目鱼肌的剪切波速度在3种体位下,差异均有统计学意义(H=35.348、52.364、30.348、45.697、51.621、39.318,P均<0.001),而腓肠肌外侧头与比目鱼肌的剪切波速度仅在最大背屈位时,差异有统计学意义(H=46.636、47.288,P均<0.001)。分别于踝关节自然位置、最大背屈位、最大跖屈位下正常对照组与糖尿病组的小腿腓肠肌内侧头、腓肠肌外侧头及比目鱼肌的剪切波数据比较,差异均有统计学意义(t=2.768、4.110、2.202、10.852、2.246、2.682、2.493、2.541、2.355、2.139,Z=-3.203、2.829、-2.698、-2.912、-3.185、-3.177、-5.439、-2.796,P均<0.05)。腓肠肌内外侧头及比目鱼肌在3种体位下剪切波速度的重复测量组内相关系数值均大于0.75,重测信度较好。结论 糖尿病可能会导致小腿腓肠肌内侧头、腓肠肌外侧头及比目鱼肌肌肉的剪切波速度降低,并且糖尿病患者小腿腓肠肌内侧头、腓肠肌外侧头及比目鱼肌的剪切波速度与踝关节体位相关,不同肌肉肌肉的剪切波速度也有差异。

Objective To investigate the shear wave velocity changes of the gastrocnemius and soleus muscles in diabetic patients by using virtual touch tissue quantification(VTQ).Methods VTQ was used to examine 35 patients with diabetes and 22 healthy people to measure the shear wave velocity of the anterior and lateral heads of the gastrocnemius muscle and the shear wave velocity of the soleus muscle at the natural position of the ankle,the maximum dorsal flexion,and the maximum plantar flexion.The shear wave velocities of different calf muscles in the same position in the diabetic group,as well as the shear wave velocity of calf muscles in the same position between the diabetic group and the normal control group were compared.Meanwhile,the test-retest reliability of shear wave elastrography was also analyzed.Results The shear wave velocities of the medial head of the gastrocnemius muscle,the lateral head of the gastrocnemius muscle,and the soleus muscle of the left and right calves showed no statistical difference(P>0.05).At the same ankle position,there was no significant difference in shear wave velocity between the medial head of the gastrocnemius muscle and the lateral head of the gastrocnemius muscle in the diabetic group(P>0.01).The shear wave velocities of the medial gastrocnemius muscle and the soleus muscle were significantly different in the three positions(H=35.348,52.364,30.348,45.697,51.621,39.318,all P<0.001),while the shear wave velocities of the lateral gastrocnemius muscle and the soleus muscle were different only at the maximum dorsal flexion(H=46.636,47.288,all P<0.001).There were significant differences in the shear wave velocities of the medial head of calf gastrocnemius muscle,the lateral head of gastrocnemius muscle,and the soleus muscle between the normal group and diabetic patients,at normal ankle position,maximum dorsal flexion position,and maximum plantar flexion position(t=2.768,4.110,2.202,10.852,2.246,2.682,2.493,2.541,2.355,2.139,Z=-3.203,2.829,-2.698,-2.912,-3.185,-3.177,-5.439,-2.796,all P<0.05).The shear wave velocities of the gastrocnemius muscle and soleus muscle at the three different positions all had excellent test-retest reliability as intraclass correlation coefficients(ICC)were all larger than 0.75.Conclusion Diabetes may decrease the shear wave velocities of the medial head of calf gastrocnemius muscle and the lateral head of the gastrocnemius muscle and soleus muscle.The shear wave velocity of the medial head of the gastrocnemius muscle and the lateral heads of the gastrocnemius muscle and the soleus muscle are affected by the position of the ankle,and the shear wave velocities of different muscles are also different.