剪切波弹性成像在脑卒中后下肢痉挛康复效果评估中的应用及外科意义

doi:10.3969/j.issn.2095-378X.2025.02.002

摘要/Abstract

摘要： 目的探讨超声剪切波弹性成像（SWE）技术在脑卒中患者下肢痉挛康复治疗疗效评估中的应用效果及其与外科干预需求的潜在关联。方法选取2023年1月—2024年12月在上海市瑞金康复医院就诊的脑卒中后单侧偏瘫下肢痉挛患者60例（研究组）及健康志愿者60名（对照组）,应用SWE技术测量对照组及康复治疗前后研究组的腓肠肌杨氏模量（YM）值,同时采用改良Ashworth量表（MAS）评估研究组康复治疗前后的下肢肌力。研究组完成治疗后,根据患侧治疗前后腓肠肌YM值变化情况分为预测手术组（患侧YM值均>健侧50%,需二次干预）和保守治疗组（无需二次干预）,比较两组治疗前YM值。结果研究组治疗后腓肠肌的YM值显著降低[（63.45±19.92） kPa vs （48.32±19.83） kPa,P<0.05],MAS评分显著改善[（2.35±1.02）分 vs （1.50±1.23）分,P<0.05]。YM值与MAS评分呈显著正相关（r=0.630,P<0.05）。预测手术组（22例）治疗前YM值为（78.35±14.18） kPa,显著高于保守治疗组（38例）的（46.19±18.40） kPa （P<0.05）。结论 SWE技术可定量分析卒中后下肢痉挛的康复疗效并预测治疗需求（治疗前YM值高的患者更易被建议外科手术干预）,为临床治疗方案制定提供客观有力的依据。

关键词: 超声, 剪切波弹性成像, 杨氏模量, 改良Ashworth量表, 腓肠肌痉挛, 脑卒中, 外科手术

Abstract: Objective To explore the application effect of ultrasound shear wave elastography （SWE） in the evaluation of efficiency of lower limb spasticity rehabilitation in stroke patients and its potential correlation with the demand for surgical treatment. Methods Sixty stroke patients with hemiplegia and spasticity in the lower limbs （research group） and 60 healthy volunteers （control group） who were treated at Shanghai Ruijin Rehabiliation Hospital from January 2023 to December 2024 were enrolled in the study. The Young’s modulus （YM） values of gastrocnemius muscle in the control group and the research group before and after rehabilitation treatment were measured by SWE, and the lower limb muscle strength of the research group before and after rehabilitation was evaluated by modified Ashworth scale （MAS）. After treatment, the research group was divided into a predictive operation group （the YM values of the affected side >50% of the healthy side, and secondary intervention was required） and a conservative treatment group （no secondary intervention was required） according to the changes of gastrocnemius muscle YM values before and after treatment to compare the YM values before treatment. Results In the research group, the YM value of the gastrocnemius muscle was significantly decreased after treatment [（63.45±19.92） kPa vs （48.32±19.83） kPa, P<0.05], and the MAS score was significantly improved [（2.35±1.02） vs （1.50±1.23）, P<0.05]. There was a positive correlation between YM and MAS scores （r=0.630, P<0.05）. Subgroup analysis showed that the predictive operation group （22 cases） had a significantly higher YM value than the conservative treatment group [（78.35±14.18） kPa vs（46.19±18.40） kPa, P<0.05]. Conclusion SWE can quantitatively analyze the rehabilitation effect of post-stroke spasticity of lower limbs and predict the demand for treatment （High YM value is potentially associated with the demand for surgical treatment）, which provides objective and powerful evidence for clinical treatment.

Key words: Ultrasound, Shear wave elastography, Young's modulus, Modified Ashworth scale, Gastrocnemius muscle spasticity, Stroke, Surgery

中图分类号:

R445.1

黄莉, 汤筱芳, 孟聪, 鲍勇, 柳俊. 剪切波弹性成像在脑卒中后下肢痉挛康复效果评估中的应用及外科意义[J]. 外科研究与新技术（中英文）, 2025, 14(2): 107-112.

HUANG Li, TANG Xiaofang, MENG Cong, BAO Yong, LIU Jun. Application and surgical significance of shear wave elastography in evaluation of rehabilitation effect of lower limb spasticity after stroke[J]. Surgical Research and New Technique, 2025, 14(2): 107-112.

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