实时剪切波弹性成像评估脑性瘫痪儿童骨骼肌硬度

Assessment of Skeletal Muscle Stiffness in Children with Spastic Cerebral Palsy by Real-time Shear Wave Elastography

目的应用实时剪切波弹性成像(SWE)定量评估痉挛型脑性瘫痪儿童肌肉硬度,为临床制订康复诊疗方案提供参考。资料与方法选取30例痉挛型脑性瘫痪儿童作为研究组,同时纳入39名年龄匹配的健康体检儿童作为对照组。治疗前采用改良Ashworth量表(MAS)对所有受试者进行肌张力评估。采用SWE测量患侧半膜肌、比目鱼肌及内侧腓肠肌的杨氏模量,并与对照组进行比较,分析杨氏模量与MAS评分的相关性。结果两组受试者内侧腓肠肌及比目鱼肌杨氏模量均高于半膜肌,差异有统计学意义(P<0.05);内侧腓肠肌与比目鱼肌杨氏模量差异无统计学意义(P>0.05)。研究组患儿治疗前患侧半膜肌、比目鱼肌、内侧腓肠肌杨氏模量均高于对照组,差异有统计学意义(t=12.97、11.49、6.15,P<0.001)。研究组患儿患侧半膜肌、比目鱼肌、内侧腓肠肌杨氏模量均与MAS评分呈正相关(r=0.592、0.309、0.718,P<0.05)。结论实时SWE可定量评估痉挛型脑性瘫痪儿童病变骨骼肌硬度,与MAS联合使用可为临床康复治疗提供参考。

Purpose To investigate the skeletal muscle stiffness with real-time shear wave elastography(SWE)in children with spastic cerebral palsy(CP),and to provide some references for making clinical rehabilitation treatment plan.Materials and Methods A total of 30 children with spastic CP and 39 children with typical development as the control group were prospectively enrolled.Before treatment,the muscular tension of subjects were all evaluated via modified Ashworth scale(MAS).SWE was used to measure and compare the Young's modulus of the semimembranous muscle,soleus muscle,and medial gastrocnemius muscle between the two groups.Results The Young's modulus of the these mimembrane muscle was significantly lower than that of the medial gastrocnemius muscle and soleus muscle between these two groups(P<0.05),while there were no statistically significant differences of the Young's modulus in the medial gastrocnemius muscle and soleus muscle between these two groups(P>0.05).Before treatment,the Young's modulus of the semimembranous muscle,soleus muscle,and medial gastrocnemius muscle in the CP group were significantly higher than that in control groups(t=12.97,11.49 and 6.15,P<0.001).The Young's modulus of the semimembranosus muscle,soleus muscle,and medial gastrocnemius muscle were showed significantly positive correlation with the MAS scores(r=0.592,0.309 and 0.718,P<0.05).Conclusion Real-time SWE demonstrates a noninvasive and quantitative evaluation of muscle stiffness in children with CP,providing clinical diagnosis and treatment plan with MAS.