声触诊弹性成像在针灸治疗脑卒中上肢痉挛患者中的临床应用

The clinical application of sound touch elastography in acupuncture treatment of stroke patients with upper limb spasm

目的探讨声触诊弹性成像(sound touch elastography,STE)在针灸治疗脑卒中上肢痉挛患者效果评估方面的临床应用价值。方法收集2020年9月至2021年3月深圳市中医院针灸科55例脑卒中后上肢痉挛患者作为脑卒中组,同期选取年龄、性别、体质指数(body mass index,BMI)相匹配的30例健康志愿者作为对照组。测量对照组优势侧与非优势侧肱二头肌、肱三头肌的剪切波速度(shear wave elastography,SWV)和脑卒中组针灸治疗前后痉挛侧和非痉挛侧肱二头肌、肱三头肌的SWV,并分析其与改良Tardieu量表(modified Tardieu scale,MTS)的痉挛等级(X)、肌肉反应角(R1)、被动运动范围(R2)以及痉挛角(R2-R1)的相关性。结果肘关节0°时,脑卒中组痉挛侧肱二头肌SWV明显大于非痉挛侧和对照组[(3.85±0.62)m/s对(3.34±0.35)m/s、(3.15±2.66)m/s,均P<0.001],针灸治疗后较治疗前SWV减小[(3.45±0.47)m/s对(3.85±0.62)m/s,P<0.001];而肘关节90°时,脑卒中组非痉挛侧肱二头肌SWV大于痉挛侧和对照组[1.98(1.92,2.14)m/s对1.98(1.92,2.11)m/s、1.95(1.86,2.05)m/s,均P<0.05],痉挛侧与对照组差异无统计学意义(P>0.05);肘关节0°和90°时,脑卒中组痉挛侧肱三头肌与对照组比较差异无统计学意义(均P>0.05)。肘关节0°时,痉挛侧肱二头肌SWV与MTS(X)呈正相关(r_(s)=0.639,P<0.001),与R1、R2呈负相关(r_(s)=-0.527、-0.825,均P<0.001)。结论STE可为针灸治疗脑卒中上肢痉挛患者的效果评估提供客观量化指标,有望成为脑卒中上肢痉挛患者临床诊断及疗效评估的有效检查手段。

Objective To explore the clinical application value of sound touch elastography(STE)in the evaluation of the curative effect of acupuncture and moxibustion in the treatment of stroke patients with upper limb spasm.Methods Fifty-five patients with upper limb spasm after stroke were selected as stroke group,and thirty healthy volunteer_(s)matched with age,gender and body mass index(BMI)were selected as control group between September 2020 and March 2021.The shear wave velocity(SWV)of biceps brachii and triceps brachii were measured in both groups.In stroke group,the SWVs of biceps brachii and triceps brachii on spastic side and non-spastic side were measured before and after acupuncture treatment,and the correlations between SWV and spastic grade(X),muscle response angle(R1),passive range of motion(R2),spastic angle(R2-R1)of modified Tardieu scale(MTS)were analyzed.Results At 0 degree,the SWV of spastic biceps brachii(3.85±0.62)m/s was significantly higher than those of the non-spastic side[(3.34±0.35)m/s]and control group[(3.15±2.66)m/s](all P<0.001),and decreased[(3.45±0.47)m/s]after acupuncture treatment(P<0.001).At 90 degree,the SWV of non-spastic biceps brachii was larger than those of spastic side and control group[1.98(1.92,2.14)m/s vs 1.98(1.92,2.11)m/s,1.95(1.86,2.05)m/s,all P<0.05],and there was no significant difference between the SWV of spastic side and control group(P>0.05).There were no significant differences in SWV of triceps brachii between the spastic side and control group at both 0 degree or 90 degree(P>0.05).At 0 degree,SWV positively correlated with MTS(x)(r_(s)=0.639,P<0.001)and negatively with R1(r_(s)=-0.527,P<0.001)and R2(r_(s)=-0.825,P<0.001)on the spastic biceps brachii.Conclusions STE can provide quantitative index for the objective evaluation of the curative effect of acupuncture in upper limb spasm after stroke,and it is proposed to be an effective means of clinical diagnosis and efficacy evaluation in patients with upper limb spasm after stroke.