超声成像技术在痉挛型脑性瘫痪患儿腓肠肌定量评定中的应用

doi:10.3969/j.issn.1006-9771.2022.09.011

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (9): 1079-1083.doi: 10.3969/j.issn.1006-9771.2022.09.011

超声成像技术在痉挛型脑性瘫痪患儿腓肠肌定量评定中的应用

祝莉洁^1,²,贠国俊^1,²,张伟云²,刘青^1,²,曹建国^1,²()

1.中国医科大学深圳市儿童医院,广东深圳市 518038
2.深圳市儿童医院康复医学科,广东深圳市 518038

收稿日期:2022-03-01 修回日期:2022-05-09 出版日期:2022-09-25 发布日期:2022-10-08
通讯作者: 曹建国 E-mail:caojgsz@126.com
作者简介:祝莉洁(1992-),女,汉族,河南周口市人,硕士研究生,主要研究方向：神经康复。|曹建国(1965-),男,汉族,山西长治市人,教授、主任医师,主要研究方向：儿童康复。
基金资助:
广东省医学科学技术研究基金项目(A2021035);深圳市科技计划项目(JCYJ20210319145942006)

Application of ultrasonography in quantitative evaluation of gastrocnemius muscles in children with spastic cerebral palsy

ZHU Lijie^1,²,YUN Guojun^1,²,ZHANG Weiyun²,LIU Qing^1,²,CAO Jianguo^1,²()

1. Shenzhen Children's Hospital of China Medical University, Shenzhen, Guangdong 518038, China
2. Department of Rehabilitation Medicine, Shenzhen Children's Hospital, Shenzhen, Guangdong 518038, China

Received:2022-03-01 Revised:2022-05-09 Published:2022-09-25 Online:2022-10-08
Contact: CAO Jianguo E-mail:caojgsz@126.com
Supported by:
Guangdong Medical Scientific Research Foundation(A2021035);Shenzhen Science and Technology Project(JCYJ20210319145942006)

摘要/Abstract

摘要：

目的探讨临床应用超声弹性成像定量评估痉挛型脑瘫患儿腓肠肌的形态结构及生物力学特性的可行性。
方法 2020年12月至2021年12月,选取深圳市儿童医院康复医学科治疗的痉挛型脑瘫(偏瘫或双瘫)患儿36例为试验组,同期招募年龄、性别匹配的健康儿童30例为对照组。二维灰阶高频超声及剪切弹性成像检查试验组偏瘫侧或肌张力较高一侧、对照组随机一侧的腓肠肌内侧头,记录肌肉厚度(MT)、肌纤维长度(FL)、羽状角(PA)和剪切波速度(SWV)。采用改良Ashworth量表(MAS)和粗大运动功能测试(GMFM)评估试验组腓肠肌肌张力和粗大运动功能。
结果试验组腓肠肌内侧头MT、FL显著小于对照组(|t| > 3.937,P < 0.001),PA、SWV显著大于对照组(|t| > 6.105,P < 0.001)。试验组MT、FL与GMFM评分呈正相关(r > 0.391, P < 0.05),SWV与MAS评分呈正相关(r = 0.734, P < 0.001)。
结论超声成像可用于量化评估痉挛型脑瘫患儿腓肠肌的形态和硬度。

关键词: 痉挛型, 脑性瘫痪, 儿童, 超声影像, 腓肠肌, 评定

Abstract:

Objective To apply ultrasonography to quantitatively evaluate the structure and biomechanical properties of gastrocnemius muscle in children with spastic cerebral palsy.
Methods From December, 2020 to December, 2021, 36 children with spastic diplegia or hemiplegia were selected as experimental group, and other 30 healthy children matched age and gender were as control group during the same period. All the subjects were measured muscle thickness (MT), muscle fiber length (FL), pinnate angle (PA) and shear wave velocity (SWV) with two-dimensional ultrasound imaging and shear wave elastography on the medial gastrocnemius of the affected side (hemiplegia), more serious side (diplegia) or random side (control group), while the gastrocnemius muscle tone and gross motor function of the experimental group were assessed with modified Ashworth Scale (MAS) and Gross Motor Function Measure (GMFM).
Results MT and FL were less in the experimental group than in the control group (|t| > 3.937, P< 0.001), while PA and SWV were more (|t| > 6.105, P < 0.001). MT and FL positively correlated to GMFM score (r > 0.391, P < 0.05), while SWV positively correlated to MAS score (r= 0.734, P < 0.001).
Conclusion Ultrasonography can be used to quantitatively evaluate the structure and stiffness of gastrocnemius muscle for children with spastic cerebral palsy.

Key words: spastic, cerebral palsy, children, ultrasonography, gastrocnemius, assessment

中图分类号:

R742.3

祝莉洁,贠国俊,张伟云,刘青,曹建国. 超声成像技术在痉挛型脑性瘫痪患儿腓肠肌定量评定中的应用[J]. 《中国康复理论与实践》, 2022, 28(9): 1079-1083.

ZHU Lijie,YUN Guojun,ZHANG Weiyun,LIU Qing,CAO Jianguo. Application of ultrasonography in quantitative evaluation of gastrocnemius muscles in children with spastic cerebral palsy[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(9): 1079-1083.

图/表 3

参考文献 37

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组别	n	性别(男/女)/n	年龄/月	体质量/kg	身高/cm	MAS评分
对照组	30	20/10	45.87±6.62	18.27±1.95	101.30±3.70
试验组	36	23/13	42.97±11.97	14.47±1.86	94.83±5.90	2.50±0.77
χ²/t值		0.056	-1.280	-8.082	-5.210
P值		0.814	0.206	< 0.001	< 0.001

组别	n	MT/mm	FL/mm	PA/°	SWV/m·s^-1
对照组	30	9.67±0.78	32.20±2.56	16.87±1.59	2.08±0.28
试验组	36	8.69±1.17	27.43±4.78	19.94±2.47	3.42±0.75
t值		-3.937	-4.909	6.105	9.858
P值		< 0.001	< 0.001	< 0.001	< 0.001

量表		MT	FL	PA	SWV
MAS	r值	-0.190	-0.114	-0.183	0.734
	P值	0.268	0.508	0.285	< 0.001
GMFM	r值	0.474	0.391	-0.179	0.126
	P值	0.004	0.018	0.297	0.464

超声成像技术在痉挛型脑性瘫痪患儿腓肠肌定量评定中的应用

Application of ultrasonography in quantitative evaluation of gastrocnemius muscles in children with spastic cerebral palsy

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