青少年特发性胸段脊柱侧弯腹壁肌群厚度与弹性的超声学特征

Ultrasonographic characteristics of thickness and elasticity of lateral abdominal muscles in adolescent with idiopathic thoracic scoliosis

为研究青少年特发性脊柱侧弯患者前外侧核心肌群的形态学与生物力学特征,选取25名10~17岁特发性胸段脊柱右侧弯患者(Cobb角为21.36°±8.26°),分别利用高频B型超声及剪切波弹性成像测量其仰卧位和站立位下的腹外斜肌、腹内斜肌和腹横肌厚度和弹性,并与25名健康青少年进行对比分析。测量了研究对象平静呼气末的肌肉厚度值及最大吸气末与最大呼气末的肌肉厚度差值(即收缩厚度差),以及平静呼气末的肌肉弹性值。厚度测量结果表明:仰卧位下,侧弯组左侧腹外斜肌较健康组更薄(P=0.03),其收缩厚度差也较大(P=0.04),侧弯组自身凸凹两侧腹横肌显著不对称(P=0.02);站立位下,侧弯组腹肌厚度与收缩厚度差均与健康组无明显差异。弹性测量结果表明:仰卧位下,侧弯组左侧腹外斜肌弹性值较右侧更大(P=0.03);站立位下,侧弯组仅左侧腹横肌弹性值较健康组更大(P=0.03)。研究结果显示青少年特发性胸段脊柱右侧弯患者腹外斜肌和腹横肌的厚度及弹性有凸凹侧差异,且与健康青少年有不同程度差异,对该类型侧弯患者进行保守治疗时可关注该肌群特点,以提高治疗效率。

In order to investigate the morphological and biomechanical characteristics of anterolateral part of core muscles in adolescent idiopathic scoliosis(AIS),the muscle thickness and elasticity of obliquus externus(OE),obliquus internus(OI)and transversus abdominis(TrA)were measured using high frequency B-mode ultrasound and shear wave elastography in supine and standing positions,respectively.25 patients aged 10~17 years with right-side thoracic scoliosis(Cobb angle was 21.36°±8.26°)and 25 healthy adolescents were observed in this study.Muscle thickness was recorded as the thickness value at the end of normal expiration and the contraction thickness difference(CTD,thickness difference between the end of maximum inspiration and the end of maximum expiration),and muscle elasticity was recorded as the measurement after the end of normal expiration.About thickness,the left OE was thinner(P=0.03)and had a greater CTD(P=0.04)than those in healthy group in supine position.Only TrA in side-difference(difference between convex and concave side)in scoliosis group was statistically significant(P=0.02).In standing position,there was no significant difference in absolute thickness and CTD between scoliosis and healthy group.For elasticity,scoliosis group had greater elasticity of the concave external abdominal oblique than the convex side in supine position(P=0.03);only left TrA in scoliosis group had greater elasticity than it in healthy group in standing position(P=0.03).It can be concluded that the thickness and elasticity of EO and TrA in adolescents with mild-to-moderate idiopathic thoracic scoliosis differ in varying degrees from those of healthy adolescents.More attention to those abdominal muscles could be paid in conservative treatment of scoliosis.