超声成像下痉挛型脑性瘫痪患儿小腿三头肌肌肉形态和结构的变化

Muscle morphology and structure change of triceps surae in children with spastic cerebral palsy by ultrasonography

目的:探讨痉挛型脑性瘫痪(脑瘫)患儿小腿三头肌肌肉形态、结构变化并探讨其与年龄、运动功能的相关性。方法:选取2~8岁痉挛型脑瘫36例(男18例,女18例),根据年龄、性别匹配20名正常儿童作为对照。超声成像下评估两组小腿三头肌羽状角、肌束长度、肌肉厚度、横截面积、肌腹长度、跟腱长度。使用88项粗大运动功能评定量表(GMFM-88)的D能区和E能区、改良Ashworth量表(MAS)评估脑瘫患儿的粗大运动功能和小腿肌肉痉挛程度。结果:痉挛型脑瘫患儿内、外侧腓肠肌肌肉厚度和横截面积,内、外侧腓肠肌和比目鱼肌肌束长度、内侧腓肠肌标准化肌腹长度小于对照组(P<0.05);内侧腓肠肌羽状角、标准化跟腱长度大于对照组(P<0.05);两组内侧腓肠肌肌肉厚度、横截面积、肌束长度均与年龄呈正相关(P<0.05)。脑瘫患儿内侧腓肠肌肌肉厚度及横截面积、外侧腓肠肌肌束长度、比目鱼肌肌肉厚度与GMFM总分呈正相关(r P分别为0.639、0.392、0.399、0.338,P<0.05),各肌肉形态参数与踝关节MAS评分不相关(P>0.05)。结论:痉挛型脑瘫患儿肌肉发育受限,且与运动功能水平密切相关,随着年龄增长,肌肉发育受限更为显著。

Aim:To explore the morphological and structural changes of triceps surae of spastic cerebral palsy(CP)children and their correlation with age and motor function.Methods:A total of 36 cases of spastic CP aged 2-8 years were selected,18 females and 18 males;20 normal children matched according to age and gender were the control.The muscle morphology and structure were assessed by ultrasound imaging,including pinnation angle,muscle fascicle length,muscle thickness,cross-sectional area,muscle belly length and achilles tendon length of triceps surae.D-energy region and E-energy region of 88 Gross Motor Function Measurement Scale(GMFM-88)and the modified Ashworth Scale(MAS)were used to evaluate gross motor function and calf muscle spasm of CP children.Results:Compared with those of control group,the muscle thickness and cross-sectional area of gastrocnemius,muscle fascicle length of gastrocnemius and soleus,and the standardized muscle belly length of medial gastrocnemius in CP group were less,and the pinnation angle of medial gastrocnemius and standardized achilles tendon length were more(P<0.05).The muscle thickness,cross-sectional area and muscle fascicle length of medial gastrocnemius in both groups were positively correlated with age(P<0.05).Thickness and cross-sectional area of medial gastrocnemius,the muscle fascicle length of lateral gastrocnemius and the thickness of soleus of CP children were positively correlated with GMFM scores,r(P)was 0.639,0.392,0.399,0.338,respectively(P<0.05),while there was no significant correlation between each muscle morphological parameter and MAS score of ankle(P>0.05).Conclusion:Children with spastic CP have limited muscle development,which is closely related to the level of motor function.The limitation of muscle development is more obvious with age.