实时剪切波弹性成像定量评估脑卒中后上肢痉挛肌肉硬度的应用价值

The study of quantitative evaluation of upper extremity spastic muscle stiffness in post-stroke using shear wave elastography

目的探讨实时剪切波弹性成像技术(SWE)定量评估脑卒中后上肢痉挛肌肉硬度的应用价值。方法选取2018年5月至2019年12月南京中医药大学附属医院针灸康复科脑卒中后偏瘫患者30例(脑卒中组)及同期健康志愿者30例(对照组),应用SWE获得2组双侧上肢肱二头肌及肱肌的杨氏模量。应用改良Ashworth量表(MAS)及改良Tardieu量表(MTS)获得脑卒中组患侧上肢肌张力评分。分析对照组中性别及优势手对肌肉杨氏模量的影响,比较脑卒中组患侧、健侧及对照组间肌肉杨氏模量差异,分析患侧肌肉杨氏模量与MAS、MTS量表评分、病程及BMI的相关性,并对SWE在上肢肌肉杨氏模量检测的可靠性进行评估。结果对照组肱二头肌及肱肌杨氏模量在优势手与非优势手及性别间差异无统计学意义(P>0.05)。脑卒中组患侧肱二头肌杨氏模量及肱肌杨氏模量分别为(42.98±20.00)、(62.50±39.30)kPa,健侧分别为(33.20±9.30)、(50.75±27.50)kPa,对照组分别为(35.68±8.70)、(50.80±14.20)kPa,患侧肱二头肌及肱肌杨氏模量明显高于健侧及对照组(P<0.01),而健侧与对照组间差异无统计学意义(P>0.05)。脑卒中组患侧肱二头肌杨氏模量与MAS、MTX-X、MTX-Y均呈正相关(分别r=0.520,P<0.05;r=0.664,P<0.01;r=0.477,P<0.05),肱肌杨氏模量仅与MTX-X呈正相关(r=0.664,P<0.01)。SWE对于脑卒中组及对照组上肢肌肉硬度测量均具有良好的可靠性。结论SWE可作为评估脑卒中后上肢肌肉痉挛的客观指标,但对不同肌肉具有差异性,SWE对于肱二头肌痉挛的定量评估与临床评估具有较好的一致性。

Objective To explore the value of shear wave elastography(SWE)in quantitative assessment of muscular stiffness of patient with upper extremity spasticity post-stroke.Methods 30 stroke patients(the stroke group)and 30 healthy volunteers(the control group)were selected to obtain the young′s modulus of biceps brachii muscle and brachialis muscle both sides by using SWE,muscle tone scores of the affected side of the stroke group were obtained by using the modified Ashworth scale(MAS)and the modified Tardieu scale(MTS).The effects of gender and dominant hand on young′s modulus of muscle in control group were analyzed.The differences of young′s modulus of the affected side,unaffected side and control group were compared,and the correlation between young′s modulus of the affected side and MAS,MTS scale score,disease course and BMI were analyzed.The reliability of SWE in young′s modulus examination of upper limb muscles was evaluated.Results There was no significant difference in the young′s modulus of biceps and brachii muscles between dominant hand and non-dominant hand and gender in the control group(P>0.05).The young′s modulus of the biceps brachii muscle and brachialis muscle of the stroke group were(42.98±20)and(62.50±39.3)kPa in the affected side,(33.2±9.3)and(50.75±27.5)kPa in the healthy side,and(35.68±8.7)and(50.80±14.2)kPa in the control group.The young′s modulus of the biceps brachii muscle and brachialis muscle of the affected side of the stroke group was significantly higher than that of the unaffected side and the control group(P<0.01),but there was no statistical difference between the unaffected side and the control group(P>0.05).The young′s modulus of the affected side biceps brachii muscle in the stroke group was positively correlated with MAS,MTX-X and MTX-Y(r=0.520,P<0.05;r=0.664,P<0.01;r=0.477,P<0.05).The brachialis young′s modulus was only positively correlated with MTX-X(r=0.664,P<0.01).The intra-class correlation coefficients of intra-rater reliability for SWV measurements were classified as excellent.Conclusion SWE can be used as an objective indicator for quantitative assessment of changes in upper limb muscle stiffness after stroke.However,considering the differences between different muscles,SWE quantitative assessment of biceps brachii has a good consistency with the clinical assessment.