SWE技术在小儿先天性肌性斜颈的诊断及非手术治疗疗效评估中的应用研究  

A study of SWE for the diagnosis of infants congenital muscular torticollis and its application in assessing the no-surgical treatment effect

作　　者：刘娜[1] 张岚[1] 乔鸿飞[1] 黄丽丽[1] 周琦[1] LIU No;ZHANG Lan;QIAO Hong-fei;HUANG Li-li;ZHOU Qi(The Second Affiliated Hospital of Xi＇an Jiaotong University,Xi＇an 710004,China)

机构地区：[1]西安交通大学第二附属医院,陕西西安710004

出　　处：《中国临床医学影像杂志》2018年第9期612-615,共4页Journal of China Clinic Medical Imaging

基　　金：陕西省社会发展科技基金(编号:2017SF-240)

摘　　要：目的:探讨实时剪切波弹性成像技术(SWE)对小儿先天性肌性斜颈的诊断价值,SWE对小儿先天性肌性斜颈非手术治疗疗效评估的临床应用价值。方法:收集2015年1月—2017年6月在我院门诊就诊的疑似小儿先天性肌性斜颈患儿102例,对其进行超声检查并应用SWE技术收集患侧和健侧胸锁乳突肌弹性模量数据。而后对确诊的患儿追踪随访其治疗过程,非手术治疗方式主要包括手法按摩、超声短波理疗。随访至治疗3月后复查超声,再次收集患儿胸锁乳突肌弹性模量数据。结果:102例患儿中,确诊为小儿先天性肌性斜颈76例,SWE技术诊断肌性斜颈的ROC曲线下面积为0.844,诊断阈值182 kPa,敏感度84.2%、特异度73.1%、阳性预测值90.1%、阴性预测值61.2%,约登指数0.573。肌性斜颈患儿胸锁乳突肌与健侧胸锁乳突肌弹性模量比较,差异有统计学意义(P<0.05)。经过非手术保守治疗后复查,患侧胸锁乳突肌弹性模量平均值较治疗前明显降低,差异有统计学意义(P<0.05)。结论:SWE为小儿先天性肌性斜颈定量诊断及治疗后的疗效评估提供了理论依据,具有一定推广应用价值。Objective： The diagnostic value of real-time shear wave elastography（SWE） to infants congenital muscular tortieollis （CMT） and the clinical application of SWE in assessing the no-surgical treatment effect of children＇s CMT were discussed. Methods： One hundred and two cases of suspected children with CMT （outpatient in our hospital from Jan. 2015 to June. 2017） were collected. All of them were examined by ultrasound and SWE was used to collect the elastic modulus data of sternocleidomastoid muscle on the affected side and the healthy side. After that, the children patients＇ therapeutic process was followed up. The no-surgical treatment mainly includes massage and ultrasonic short wave physiotherapy. When a followup to three months was fulfilled, ultrasound reexamination was performed and the elastic modulus data of the children patients＇ sternocleidomastoid muscle was recollected. Results： In the 102 cases of children patients, 76 cases were diagnosed with CMT. The area under ROC curve of diagnosing CMT by SWE was 0.844, and the diagnostic threshold was 182 kPa, and the sensitivity was 84.2%, and the specificity was 73.1%, and the positive predictive value was 90.1%, and the negative pre- dictive value was 61.2%, and the Youden index was 0.573. To the children patients with CMT, a comparison of the elastic modulus data between sternocleidomastoid muscle on the affected side and the healthy side was performed, and the difference is statistically significant（P〈0.05）. Through the reexamination after no-surgical conservative treatment, the average elastic modu- lus value of sternocleidomastoid muscle on the affected side was significantly reduced, and the difference is statistically signifi- cant（P〈0.05）. Conclusion： Real-time SWE yields theoretical foundations to the diagnosis and the treatment effect evaluation of infants CMT. It embraces a certain value of popularization and application.

关 键 词：斜颈 超声检查 多普勒 彩色 

分 类 号：R682.12[医药卫生—骨科学] R445.1[医药卫生—外科学]