剪切波弹性成像技术量化评估健康人斜方肌弹性模量的应用

Assessing elastic modulus of the upper trapezius muscle among healthy subjects by shear wave elastography

目的探讨剪切波弹性成像技术(SWE)量化评估颈椎屈曲不同角度斜方肌弹性模量的应用价值。方法2018年10月至2019年1月于河南省洛阳正骨医院招募20名健康成年男性实习医师作为试验对象。在受试者颈椎屈曲0°和30°时,测试人员A和B分别使用SWE量化评估斜方肌上束剪切模量,5 d后测试者A进行重复评估。记录颈椎屈曲0°和30°时,利手侧和非利手侧斜方肌的弹性模量。使用同类相关系数(ICC)进行信度试验,验证重测信度和测试者间信度,采用配对t检验分析颈椎屈曲不同角度利手侧与非利手侧斜方肌上束弹性模量的差异。结果使用SWE技术评估斜方肌上束弹性的重测信度和测试者间信度均为优秀(ICC=0.77~0.86,ICC=0.86~0.98)。在颈椎屈曲0°和30°时,斜方肌上束剪切模量分别为(40.47±11.37)kPa、(49.52±14.46)kPa,相比增加了22.36%,最小检测变化值为7.04 kPa。此外,在颈椎屈曲0°和30°时,利手侧斜方肌上束剪切模量均高于非利手侧[(40.47±11.37)kPa vs(35.25±9.46)kPa;(49.52±14.46)kPa vs(43.87±10.61)kPa],差异具有统计学意义(t=4.64,P<0.001;t=3.27,P=0.001)。结论SWE在量化评估健康人斜方肌弹性模量试验中信度高,并能够客观地评估颈椎屈曲过程中斜方肌上束剪切模量的变化、最小检测变化值以及利手侧和非利手侧弹性模量的差异,由此可知,SWE在评估肌肉骨骼组织方面具有一定的优势。

Objective To determine the elastic modulus of the upper trapezius muscle during the cervical flexion by shear wave elastography(SWE).Methods Twenty healthy male individuals were recruited from Luoyang Orthopedic-Traumatological Hospital in this study.During the cervical flexion at 0°and 30°,upper trapezius muscle elasticity was assessed by operators A and B.Five days later,the muscle was evaluated again by operator A.In addition,the upper trapezius muscle on the dominant and non-dominant side was assessed during the cervical flexion.The reliability was evaluated using the intraclass correlation coefficient(ICC)and a paired t-test was performed to compare the difference in the elastic modulus of the upper trapezius muscle during the cervical flexion between the two sides.Results During the cervical flexion at 0°and 30°,the intra-operator reliabilities of assessing upper trapezius elastic properties by SWE were good(ICC=0.77~0.86)and inter-operator reliabilities(ICC=0.86~0.98)were excellent.The upper trapezius stiffness was(40.47±11.37)kPa during the cervical flexion at 0°and(49.52±14.46)kPa at 30°,with an increase of 22.36%and the minimal detectable change(MDC)was 7.04 kPa.In addition,the upper trapezius elastic modulus on the dominant side was significantly stiffer than that on the non-dominant side during the cervical flexion at 0°and 30°[(40.47±11.37)kPa vs(35.25±9.46)kPa,t=4.64,P<0.001;(49.52±14.46)kPa vs(43.87±10.61)kPa,t=3.27,(P=0.001)].Conclusion SWE is an effective technique for evaluating the elastic modulus of the upper trapezius muscle with high reliability and repeatability.Therefore,SWE has the advantage of assessing the elasticity of the musculoskeletal system.