超声定量评估脑卒中下肢痉挛性瘫痪患者肉毒毒素治疗效果  

Efficacy of botulinum toxin injection in the treatment of lower limb spastic muscles in stroke patients by quantitative ultrasound evaluation

作　　者：束华 姚骐羽 叶新华[1] 李奥[1] SHU Hua;YAO Qiyu;YE Xinhua;LI Ao(Department of Ultrasound Diagnosis,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院超声诊断科,南京市210029 [2]南京大学鼓楼医院超声诊断科

出　　处：《临床超声医学杂志》2024年第12期980-985,共6页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨超声定量评估脑卒中下肢痉挛性瘫痪患者A型肉毒毒素治疗效果的临床价值。方法选取我院行A型肉毒毒素注射治疗的脑卒中下肢痉挛性瘫痪患者22例(卒中组)和同期20例健康体检者(对照组),应用二维超声和剪切波弹性成像获取两组腓肠肌内侧头、腓肠肌外侧头、比目鱼肌治疗前及治疗后1周、4周超声定量参数,包括平均灰度值(MGV)、肌肉厚度、肌束长度、羽状角及剪切波速度(SWV)平均值、最大值。采用Brunnstrom分期和改良Ashworth量表(MAS)对卒中组进行临床康复评估。比较卒中组治疗前与对照组超声定量参数,以及卒中组治疗前后超声定量参数、Brunnstrom评分、MAS评分的差异。分析治疗前超声定量参数与治疗后Brunnstrom评分和MAS评分的相关性。结果卒中组治疗前腓肠肌内侧头肌肉厚度和肌束长度均小于对照组,腓肠肌内侧头和比目鱼肌MGV、SWV平均值、SWV最大值均大于对照组,差异均有统计学意义(均P<0.05)。卒中组治疗前及治疗后1周、4周腓肠肌内侧头和比目鱼肌SWV平均值比较差异均有统计学意义(均P<0.05),治疗后1周、4周均较治疗前减小(均P<0.05)。卒中组治疗后腓肠肌内侧头及比目鱼肌MAS评分均较治疗前减小,Brunnstrom评分均较治疗前增大,差异均有统计学意义(均P<0.05)。相关性分析显示,治疗前腓肠肌内侧头MGV与治疗后MAS评分呈正相关(r=0.435,P<0.05);其余参数与治疗后Brunnstrom评分和MAS评分均无相关性。结论超声可定量反映脑卒中下肢痉挛性瘫痪患者的肌肉改变情况,有效评估肉毒毒素注射治疗效果,具有一定的临床价值。Objective To explore the clinical value of quantitative ultrasound in evaluating the efficacy of botulinum toxin A injection in the treatment of lower limb spastic muscles in stroke patients.Methods A total of 22 stroke patients with lower limb spastic muscles treated by botulinum toxin A injection(stroke group)and 20 healthy subjects underwent physical examination during the same period(control group)were included.Two-dimensional ultrasound and shear wave elastography were applied to obtain the ultrasonic quantitative parameters of medial head of gastrocnemius muscle,lateral head of gastrocnemius muscle,soleus muscle in both control group and the stroke group before and 1,4 weeks after the treatment,including mean gray value(MGV),muscle thickness,fascicle length,pennate angle,mean shear wave velocity(SWVmean)and maximum shear wave velocity(SWVmax).Brunnstrom staging and modified Ashworth scale(MAS)were used to evaluate the clinical rehabilitation in the stroke group.The difference of ultrasonic quantitative parameters between the stroke group before treatment and control group,the difference of ultrasonic quantitative parameters,Brunnstrom score and MAS score in the stroke group before and after treatment were compared.The correlation between ultrasonic quantitative parameters before treatment and Brunnstrom score,MAS score were analyzed.Results Before the treatment,the muscle thickness and fascicle length of medial head of gastrocnemius muscle in the stroke group were significantly decreased compared with those in control group,while the MGV,SWVmean,SWVmax of medial head of gastrocnemius muscle and soleus muscle were significantly increased,the differences were statistically significant(all P<0.05).There were significant differences in SWVmean of medial head of gastrocnemius muscle and soleus muscle in stroke group before and after 1,4 weeks of treatment(all P<0.05).Compared with the results before treatment,the MAS score of medial head of gastrocnemius and soleus muscles after treatment in the stroke group wer

关 键 词：超声检查 二维 剪切波弹性成像 脑卒中 痉挛性瘫痪 A型肉毒毒素 疗效 

分 类 号：R445.1[医药卫生—影像医学与核医学]