剪切波超声弹性成像与痉挛临床评估的相关性分析  

Analysis of correlation between shear wave ultrasound elastography and clinical spasticity scales

作　　者：郭雪园 王月香[2] 崔建博 解涛[1] 贾子善[1] 张立宁[1] Guo Xueyuan;Wang Yuexiang;Cui Jianbo(Department of Rehabilitation Medicine,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心康复医学科,北京100853 [2]解放军总医院第一医学中心超声科,北京100853

出　　处：《中华保健医学杂志》2020年第5期481-483,共3页Chinese Journal of Health Care and Medicine

基　　金：国家重点研发计划项目(2019YFB1311400);解放军总医院军事医学科研项目(CX19005)。

摘　　要：目的应用剪切波弹性超声成像技术测量脑卒中患者不同屈肘角度和深度时痉挛肱二头肌(BBM)的剪切波速度(SWV),并探索SWV值与痉挛临床评估指标是否有相关性。方法选取2019年06月~2020年2月解放军总医院收治的脑卒中偏瘫患者35例,应用剪切波弹性超声成像技术分别测量痉挛侧BBM屈肘90°和完全伸肘时浅层和深层的SWV值,并进行改良Ashworth量表、改良Tardieu量表、Fugl-Meyer上肢运动功能、关节活动范围等临床评估,采用Spearman分析SWV值和临床评估指标之间的相关性。结果不论浅层或深层,屈肘90°时BBM的SWV值与改良Tardieu分级、Fugl-Meyer上肢评分均有显著相关性,与改良Ashworth分级、痉挛角、肘关节被动关节活动度(PROM)无显著相关性;当完全伸肘时,BBM的SWV值与改良Ashworth分级、改良Tardieu分级、痉挛角、Fugl-Meyer上肢评分、肘关节被动关节活动范围均有显著相关性;SWV值与肘关节主动关节活动范围无显著相关性。结论剪切波弹性超声成像技术可定量评估脑卒中后痉挛BBM的痉挛程度,为帮助临床决策和指导干预手段提供了可能。Objective To quantitatively evaluate the shear wave velocity(SWV)of spastic biceps brachii muscle(BBM)at different angles of elbow flexion and layers by real-time shear wave ultrasound elastography,and to explore the relationship between SWV and clinical spasticity scales.Methods Thirty five patients with post-stroke hemiplegia were included.The SWV of spastic BBM at different angles of elbow flexion and layers were measured.At the same time,clinical spasticity scales such as modified Ashworth scale,Modified Tardieu scale,Fugl-Meyer Assessment for upper extremity and the range of motion of elbow were carried out.Analyzed the relationship between SWV and clinical spasticity scales by spearman.Results The SWV of BBM was significantly correlated with Modified Tardieu Scale and Fugl-Meyer Assessment score at 90°elbow flexion at whether superficial layer or deep layer,but not significantly with Modified Ashworth Scale,spasm Angle or passive range of motion.When the elbow at fully extended,the SWV of BBM was significantly correlated with modified Ashworth scale,Modified Tardieu Scale,spasm Angle,Fugl-Meyer Assessment for upper extremity and passive range of motion.There was no significant correlation between SWV and active range of motion.Conclusion The real-time shear wave ultrasound elastography can quantitatively evaluate the spasticity in BBM of patients with post-stroke hemiplegia,which may contribute to clinical decision and intervention.

关 键 词：剪切波弹性成像 痉挛 肱二头肌 改良Ashworth量表 改良Tardieu量表 

分 类 号：R743[医药卫生—神经病学与精神病学]