基于剪切波弹性成像技术探讨“通络”技术改善痉挛型脑瘫患儿腓肠肌肌肉硬度和肌张力的临床疗效  

Clinical efficacy analysis of“Tongluo”technique on gastrocnemius muscle hardness and muscle tone in children with spastic cerebral palsy using shear wave elastography

作　　者：李瑞仕[1] 徐文雅 陈瑞泽 刘斌[1] 徐彩超 王燕飞 贺思[1] Li Ruishi;Xu Wenya;Chen Ruize;Liu Bin;Xu Caichao;Wang Yanfei;He Si(Department of Pediatrics,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300381,China;School of Graduate,Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China)

机构地区：[1]天津中医药大学第一附属医院儿科,国家中医针灸临床医学研究中心,天津300381 [2]天津中医药大学研究生院,天津301617

出　　处：《国际生物医学工程杂志》2023年第5期454-460,共7页International Journal of Biomedical Engineering

基　　金：天津中医药大学第一附属医院“拓新工程”基金项目(201901)。

摘　　要：目的基于实时剪切波弹性成像技术(SWE)探讨“通络”技术改善痉挛型脑瘫(SCP)患儿腓肠肌肌肉硬度和肌张力的临床疗效。方法选取2020年1月至2021年6月诊治于天津中医药大学第一附属医院的40例SCP患儿为观察组,予“通络”技术;20例正常儿童为对照组,不予干预。比较两组在基线及治疗1.5、3个月腓肠肌内侧静息状态的杨氏模量值、改良Ashworth量表(MAS)评分和临床痉挛指数(CSI)评分,及SCP患儿治疗前后肌张力和痉挛程度的变化,分析不同MAS、CSI分级间杨氏模量的差异,及两者与杨氏模量的相关性。结果基线及治疗1.5、3个月,对照组杨氏模量值比较差异均无统计学意义(均P>0.05);观察组杨氏模量值、MAS评分、CSI总分随着治疗疗程的增加逐渐降低,基线处及治疗1.5、3个月三者两两相比差异均具有统计学意义(均P<0.01)。与对照组同期比较,观察组杨氏模量值升高,差异有统计学意义(P<0.01)。MAS分级统计,观察时点杨氏模量均随着肌张力的增高而增加,两者存在正相关(P<0.01),各级肌张力之间的杨氏模量值差异具有统计学意义(P<0.05)。CSI分级统计,观察时点杨氏模量均随着痉挛程度的增高而增加,两者存在正相关(P<0.01),不同痉挛程度之间的杨氏模量值差异具有统计学意义(P<0.05)。结论SCP患儿肌肉硬度较正常儿童高,“通络”技术能有效改善SCP患儿肌肉硬度,降低患儿肌张力,有效改善肌肉痉挛状态,可能与调整肌肉内部结构从而降低肌肉硬度相关,为临床康复与评估提供指导性意见。Objective To investigate the clinical effect of the“Tongluo”technique on gastrocnemius muscle hardness and muscle tone in children with spastic cerebral palsy(SCP)using shear wave elastography(SWE).Methods Forty children with SCP who were treated at the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from January 2020 to June 2021 were selected as the observation group and received the“Tongluo”technique intervention.At the same time,20 normal children were selected as the control group,without any intervention.Compare the various indicators of the two groups at baseline and after 1.5 and 3 months of treatment,including Young’s modulus value of the medial gastrocnemius muscle at rest,the modified Ashworth scale(MAS)score,and the clinical spasm index(CSI)score.The changes in muscle tone and spasticity of SCP children before and after treatment were compared,and the differences in the Young’s modulus between MAS and CSI levels in SCP children as well as the correlation between MAS,CSI,and Young’s modulus were analyzed.Results The difference in Young’s modulus values of the control group at baseline,after 1.5 and 3 months of treatment was not statistically significant(all P>0.05).At baseline,after 1.5 and 3 months of treatment,Young’s modulus value,MAS score,and total CSI score gradually decreased in the observation group,and the differences obtained from pairwise comparisons were statistically significant(all P<0.01).At the same intervention stage,Young’s modulus value of the observation group was higher than that of the control group,with a statistically significant difference(P<0.01).The MAS score results showed that Young’s modulus of the observation group increased with the increase in muscle tone,and there was a positive correlation between Young’s modulus and muscle tone(P<0.01),and the difference in Young’s modulus corresponding to different muscle tones was statistically significant(P<0.05).The CSI score results showed that the Young’s modulus of th

关 键 词：“通络”技术 剪切波弹性成像技术 痉挛型脑瘫 肌肉硬度 肌张力 

分 类 号：R277.7[医药卫生—中医学]