多模态超声成像在脑卒中患者腓肠肌痉挛评估中的应用

doi:10.3969/j.issn.1006-9771.2021.07.009

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (7): 791-796.doi: 10.3969/j.issn.1006-9771.2021.07.009

多模态超声成像在脑卒中患者腓肠肌痉挛评估中的应用

陈明珍^1a,姜凡^1a(),单永^1a,洪永锋^1b,刘学^1a,肖洪波²,陈瑞全²

1.安徽医科大学第二附属医院, a. 超声诊断科; b. 康复科, 安徽合肥市 230601
2.安徽中医药大学第一附属医院针灸康复中心一科, 安徽合肥市 230031

收稿日期:2020-11-16 修回日期:2021-06-02 出版日期:2021-07-25 发布日期:2021-07-28
通讯作者: 姜凡 E-mail:ahultrasound2005@126.com
作者简介:陈明珍(1994-),女,汉族,安徽淮北市人,硕士研究生,主要研究方向：肌骨超声。|姜凡(1964-),女,汉族,安徽合肥市人,副教授、主任医师,主要研究方向：肌骨超声、妇产超声。

Measurement of Structure and Stiffness of Gastrocnemius Muscle for Stroke Patients with Multimodal Ultrasound Imaging

CHEN Ming-zhen^1a,JIANG Fan^1a(),SHAN Yong^1a,HONG Yong-feng^1b,LIU Xue^1a,XIAO Hong-bo²,CHEN Rui-quan²

1. a. Department of Ultrasonic Diagnosis; b. Rehabilitation Department, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
2. Department of Acupuncture and Moxibustion Rehabilitation Center, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui 230031, China

Received:2020-11-16 Revised:2021-06-02 Published:2021-07-25 Online:2021-07-28
Contact: JIANG Fan E-mail:ahultrasound2005@126.com

摘要/Abstract

摘要：

目的探讨多模态超声成像在量化评估脑卒中偏瘫患者肌肉痉挛中的应用。

方法 2019年3月至9月,本院脑卒中下肢偏瘫患者44例为试验组,同期健康体检者46例为对照组,对试验组健侧、患侧及对照组右侧腓肠肌内侧头同一位置行二维灰阶超声、剪切波弹性成像和超微血管成像超声检查,记录剪切波速度(SWV)、血流信号值、羽状角(PA)、肌肉厚度(MT)、肌纤维长度(FL)。

结果试验组患侧SWV明显高于健侧和对照组(t > 6.346, P < 0.01)。静息状态下,试验组患侧FL较健侧和对照组明显缩短(|t| > 6.235, P < 0.01),MT和PA与健侧有显著性差异(|t| > 2.198, P < 0.05);血流信号值低于对照组(t = 2.604, P < 0.05);最大等长收缩状态下,FL缩短较健侧和对照组显著减小(Z > 6.703, P < 0.001)。

结论超声成像技术能从肌肉结构、血流和硬度等方面定量评价脑卒中患者腓肠肌变化,可为痉挛的诊断和随访提供客观资料。

关键词: 脑卒中, 痉挛, 超声, 肌张力, 评定

Abstract:

Objective To apply multimodal ultrasound imaging in spasticity assessment for stroke patients with hemiplegia.

Methods From March to September, 2019, 44 inpatients with lower limb spastic hemiplegia after stroke (patients) and 46 healthy volunteers (controls) were scanned with two-dimensional ultrasound imaging, shear wave elastography and super microvascular imaging at the same area of gastrocnemius muscle of both sides of patients and right side of controls, in resting and maximum isometric contraction. The parameters of shear wave velocity (SWV), blood flow signal, pinnation angle (PA), fascicle length (FL) and muscle thickness (MT) were recorded.

Results SWV increased in the affected side of the patients compared with those of the unaffected side and controls in resting (t > 6.346, P < 0.01), while FL shortened (|t| > 6.235, P < 0.01), MT and PA changed compared with those of the unaffected side (|t| > 2.198, P < 0.05), and blood flow signal decreased compared with those of the controls (t = 2.604, P < 0.05). In maximum isometric contraction, the decrease of FL was less compared with those of the unaffected side and controls (Z > 6.703, P < 0.001).

Conclusion Ultrasound imaging can quantitatively evaluate spasticity of gastrocnemius muscle for patients with stroke in terms of morphological structure, blood flow, and muscle stiffness.

Key words: stroke, spasticity, ultrasound, muscular tension, assessment

中图分类号:

R743.3

陈明珍,姜凡,单永,洪永锋,刘学,肖洪波,陈瑞全. 多模态超声成像在脑卒中患者腓肠肌痉挛评估中的应用[J]. 《中国康复理论与实践》, 2021, 27(7): 791-796.

CHEN Ming-zhen,JIANG Fan,SHAN Yong,HONG Yong-feng,LIU Xue,XIAO Hong-bo,CHEN Rui-quan. Measurement of Structure and Stiffness of Gastrocnemius Muscle for Stroke Patients with Multimodal Ultrasound Imaging[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(7): 791-796.

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参考文献 41

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组别	n	性别(男/女, n)	年龄(岁)	类型(出血/梗死, n)	偏瘫侧(左/右,n)
对照组	46	32/14	53.83±10.25
试验组	44	33/11	53.43±13.54	29/15	25/19
χ²/t值		0.156	0.331
P值		0.876	0.565

组别	n	FL(mm)	MT(mm)	PA(°)	SWV(m/s)	SMI(%)
对照组	46	48.05±2.15	13.75±2.68	13.07±3.23	2.69±0.40	7.49±2.11
试验组健侧	44	47.69±3.31	11.14±2.55	12.02±2.93	2.72±0.56
试验组患侧	44	43.22±3.40	12.25±2.21	14.64±3.18	3.70±0.85	6.28±2.31
t₁值		-6.235	2.198	4.006	6.346
P₁值		< 0.001	0.031	<0.001	< 0.001
t₂值		-8.073	-2.881	2.326	7.119	2.604
P₂值		< 0.001	0.005	0.022	< 0.001	0.011

组别	n	差值
对照组	46	10.91±4.23
试验组健侧	44	9.10±4.06
试验组患侧	44	3.52±1.94
Z₁值		2.055
P₁值		0.040
Z₂值		6.703
P₂值		< 0.001
Z₃值		7.318
P₃值		< 0.001

多模态超声成像在脑卒中患者腓肠肌痉挛评估中的应用

Measurement of Structure and Stiffness of Gastrocnemius Muscle for Stroke Patients with Multimodal Ultrasound Imaging

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