剪切波超声弹性成像联合电刺激引导注射A型肉毒素治疗脑卒中后上肢痉挛性偏瘫的疗效评估  

Assessing the therapeutic outcomes of shear wave ultrasound elastography plus electrical stimulation-guided botulinum toxin A injection for post-stroke upper limb spastic hemiplegia

作　　者：郑直 许利 程伟波 韩雨农 朱林丽 李文 李杜娟 ZHENG Zhi;XU Li;CHENG Weibo;HAN Yunong;ZHU Linli;LI Wen;LI Dujuan(Department of Ultrasound,The Second Affiliated Hospital of Wannan Medical College,Wuhu 241000,Anhui,China)

机构地区：[1]皖南医学院第二附属医院超声医学科,安徽芜湖241000 [2]皖南医学院第二附属医院神经内科,安徽芜湖241000 [3]皖南医学院第二附属医院康复医学科,安徽芜湖241000

出　　处：《皖南医学院学报》2025年第1期42-46,共5页Journal of Wannan Medical College

基　　金：芜湖市卫健委重点课题(WHWJ2023z008)。

摘　　要：目的:探讨剪切波弹性成像评估超声联合电刺激引导注射A型肉毒素治疗脑卒中后上肢痉挛性偏瘫的疗效。方法:选取2021年1月~2023年12月皖南医学院第二附属医院康复医学科被确诊为脑卒中后上肢痉挛性偏瘫患者51例,所有患者均在高频超声联合电刺激引导下注射A型肉毒素于指浅屈肌(Fds)、指深屈肌(Fdp)、肱二头肌(Bb)、桡侧腕屈肌(Fcr)、尺侧腕屈肌(Fcu)。比较患者治疗前后各肌肉的杨氏模量平均值(Emean),以及Brunnstorm分级,改良Ashworth量表(MAS)及日常生活活动能力(ADL)评分的差异性。结果:①患者在治疗前、治疗后1个月、治疗后3个月Fds、Fdp、Bb、Fcr、Fcu的Emean值均依次下降(P<0.05),MAS评分、Brunnstorm评分均依次升高(P<0.05),治疗后3个月ADL评分较治疗前升高(P<0.05);②Spearman相关性分析显示,治疗后3个月Fds、Fdp、Bb、Fcr、Fcu的Emean值与MAS评分呈负相关(r=-0.715、-0.802、-0.761、-0.708、-0.725,P<0.001);③多因素Logistic回归分析显示Fdp和Fcu的治疗后3个月与治疗前的差值越大治疗效果越明显,P<0.05;④ROC曲线显示Fdp、Fcu的治疗后3个月Emean与治疗前的差值诊断疗效的截断值分别为6.050、5.105 kPa,曲线下面积分别为0.830(95%CI:0.700~0.959)、0.891(95%CI:0.802~0.979),灵敏度分别为94.4%、83.3%,特异度分别为60.0%、80.0%。结论:剪切波超声弹性成像联合电刺激引导注射A型肉毒素治疗脑卒中后上肢痉挛性偏瘫疗效明显,且剪切波弹性成像可以较准确量化地评估疗效,为临床诊疗提供重要依据。Objective:To evaluate the therapeutic outcomes of shear wave ultrasound elastography plus electrical stimulation-guided botulinum toxin A injection for post-stroke upper limb spastic hemiplegia.Methods:Fifty-one patients diagnosed with post-stroke upper limb spastic hemiplegia in Rehabilitation Medicine Department of our hospital were enrolled from January 2021 to December 2023.All patients were injected with botulinum toxin type A into the flexor digitorum superficialis(Fds),flexor digitorum profundus(Fdp),biceps brachii(Bb),flexor carpi radialis(Fcr),and flexor carpi ulnaris(Fcu)under the guidance of high-frequency ultrasound combined with electrical stimulation.The patients were compared in terms of the differences in average Young′s modulus(Emean)values of each muscle,Brunnstrom grading,Modified Ashworth Scale(MAS),and ADL scores before and after treatment.Results:①The Emean values of Fds,Fdp,Bb,Fcr,and Fcu in all patients were decreased sequentially before treatment,one month,and three months after treatment(P<0.05),and the MAS scores and Brunstorm grading scores were increased sequentially(P<0.05).The ADL scores at three months after treatment were higher than before treatment(P<0.05);②Spearman correlation analysis showed that the Emean values of Fds,Fdp,Bb,Fcr and Fcu were negatively correlated with MAS score at three months after treatment(r=-0.715,-0.802,-0.761,-0.708 and-0.725,P<0.001);③Multivariate logistic regression analysis showed that a larger difference in the Emean values of Fdp and Fcu between three months after treatment and before treatment indicated better effects(P<0.05);④The ROC curve showed that the cut-off values for diagnostic efficacy,based on the difference in Emean values of Fdp and Fcu between three months after treatment and before treatment,were 6.050 kPa and 5.105 kPa,respectively.The areas under the ROC curves were 0.830(95%CI:0.700-0.959)and 0.891(95%CI:0.802-0.979),with sensitivity of 94.4%and 83.3%,and specificity of 60.0%and 80.0%,respectively.Conclusion:Shear wave

关 键 词：剪切波弹性成像 高频超声 电刺激 A型肉毒素 痉挛性偏瘫 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R[医药卫生—临床医学]