剪切波弹性成像技术评估肩胛动力障碍患者和健康成人肩胛带肌厚度与弹性模量的对比研究

Comparison of shear wave elastic imaging technique for elastic modulus of shoulder girdle muscles in healthy adults and patients with scapular dyskinesis

目的探讨剪切波弹性成像(SWE)技术定量评估肩胛动力障碍(SD)患者与健康成人肩胛带肌厚度与弹性模量的应用价值。方法前瞻性病例对照研究。纳入2019年3—9月中国康复研究中心北京博爱医院骨科33例(33肩)SD患者为SD组,其中男10例、女23例,年龄35~71岁;另招募同期健康志愿者32例(61肩)为对照组,其中男10例、女22例,年龄22~74岁。采用二维灰阶超声和SWE测量两组受试者的上斜方肌(UT)、肩胛提肌(LS)、中斜方肌(MT)、菱形肌(RM)、下斜方肌(LT)、前锯肌(SA)的厚度、剪切波速度,并计算弹性模量值。比较SD患者与健康成人的肩胛带肌厚度与弹性模量变化,分析年龄、性别对肩胛带肌厚度与弹性模量的影响。结果SD患者的LS厚度、UT弹性模量、UT与MT弹性模量比和UT与LT弹性模量比分别为(0.40±0.11)cm、(44.42±29.17)kPa(1 mmHg=0.133 kPa)、1.59±0.56、1.56±0.63,健康成人分别为(0.47±0.17)cm、(31.00±12.68)kPa、1.30±0.30、1.30±0.30,SD患者LS厚度小于健康成人,UT弹性模量、UT与MT弹性模量比、UT与LT弹性模量比均大于健康成人,差异均具有统计学意义(P值均<0.05)。同年龄段的SD患者与健康成人比较:青年(18~40岁)SD患者的RM弹性模量为(31.14±3.93)kPa大于健康青年人(23.30±8.24)kPa,中年(41~60岁)SD患者的UT与SA弹性模量比为1.57±0.38大于健康中年人1.30±0.33,老年(61~80岁)SD患者的UT与MT弹性模量比、UT、LS和SA弹性模量分别为1.81±0.68、(53.59±36.99)kPa、(36.54±11.41)kPa、(18.51±8.05)kPa,健康老年人分别为1.40±0.39、(32.01±11.93)kPa、(28.82±9.42)kPa、(13.04±7.23)kPa,老年SD患者均大于健康老年人,差异均有统计学意义(P值均<0.05)。在SD患者和健康成人中,男性的SA厚度分别为(0.82±0.24)cm和(0.80±0.17)cm,女性分别为(0.63±0.15)cm和(0.69±0.17)cm,男性SA厚度均大于女性;而且在健康成人中,女性的UT弹性模量为(32.91±13.87)kPa,大于男性的(26.77±8.37)kPa:差异均有统计学意义(P值均<0.05)。在健康成人中,SA厚度、LT弹性模量、SA弹性模量均与年龄增长呈负相关(r=-0.334、-0.416、-0.431),而UT与LT弹性模量比、UT与SA弹性模量比均与年龄增长呈正相关(r=0.317、0.300);在SD患者中,UT与MT弹性模量比、LS弹性模量均与年龄增长呈正相关(r=0.410、0.399),而RM弹性模量与年龄增长呈负相关(r=-0.402):差异均具有统计学意义(P值均<0.05)。结论SWE可用于定量评估肩胛带肌弹性模量,可反映SD患者肩胛带肌力偶失衡的特点,对SD的预防、早期诊断与精准化康复治疗具有一定的指导意义。

Objective This study aims to explore the application value of quantitatively evaluating and comparing the elastic modulus of shoulder girdle muscles between healthy adults and patients with scapular dyskinesis by using shear wave elastography(SWE).Methods A case-control study was conducted.From Mar 2019 to Sep 2019,33 patients(33 shoulders)with scapular dyskinesis(SD)including 10 males and 23 females aged 35 to 71 years from China Rehabilitation Research Center were selected into SD group.In the same period,32 healthy volunteers(61 shoulders)including 10 males and 22 females aged from 22 to 74 years were also recruited as control group.Thickness,shear wave velocity of upper trapezius(UT),levator scapulae(LS),middle trapezius(MT),rhomboid(RM),lower trapezius(LT),and serratus anterior(SA)were measured with 2-D ultrasound and SWE.Elastic modulus was calculated.Thickness and elastic modulus of shoulder girdle muscles were compared between SD and control groups,and the effects of age and sex on thickness and elastic modulus of shoulder girdle muscles were analyzed.Results Patients with SD had higher elastic modulus of UT,UT/MT,UT/LT(44.42±29.17)kPa(1 mmHg=0.133 kPa),1.59±0.56,and 1.56±0.63 than healthy adults(31.00±12.68)kPa,1.30±0.30,and 1.30±0.30,but had lower thickness of LS(0.40±0.11)cm than healthy adults(0.47±0.17)cm,and the differences were statistically significant(all P values<0.05).The elastic modulus of RM in young patients with SD(31.14±3.93)kPa was higher than that of young healthy adults(23.30±8.24)kPa.The UT/SA in middle-aged patients with SD(1.57±0.38)was greater than that of middle-aged healthy adults(1.30±0.33).Moreover,the UT/MT,the elastic modulus of UT,LS,and SA in elderly patients with SD[1.81±0.68,(53.59±36.99)kPa,(36.54±11.41)kPa,(18.51±8.05)kPa]were greater than those of elderly healthy adults[1.40±0.39,(32.01±11.93)kPa,(28.82±9.42)kPa,(13.04±7.23)kPa].The differences were statistically significant(all P values<0.05).Among the 32 healthy adults and 33 patients with SD,SA was significantly thicker in males[(0.82±0.24)cm and(0.80±0.17)cm]than in females[(0.63±0.15)cm and(0.69±0.17)cm].Furthermore,the elastic modulus of UT was greater in females[(32.91±13.87)kPa than in males(26.77±8.37)kPa],and the difference was statistically significant(all P values<0.05).Among the 32 healthy adults,SA thickness,elastic modulus of LT,and SA were negatively associated with age(r=-0.334,-0.416,-0.431).UT/LT and UT/SA were positively associated with age(r=0.317,0.300).Among the 33 patients with SD,UT/MT and elastic modulus of LS were positively associated with age(r=0.410,0.399).However,the elastic modulus of RM was negatively associated with age(r=-0.317,-0.300),and the difference was statistically significant(all P values<0.05).Conclusions SWE can be used to quantify the elastic modulus of shoulder girdle muscles and can reflect the characteristics of imbalance of scapular muscle couple in patients with SD.This work provides certain guiding significance for prevention,early diagnosis,and precision rehabilitation of SD.