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。
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.
[1] Jzkubowski KL, Terman A, Santana VC, et al.Passive material properties of stroke-impaired plantarflexor and dorsiflexor muscles[J]. Clin Biomech (Bristol, Avon), 2017,49(11):48-55.
[2] Hong MJ, Park JB, Lee YJ, et al.Quantitative evaluation of post-stroke spasticity using neurophysiological and radiological tools: a pilot study[J]. Ann Rehabil Med, 2018, 42(3): 384-395.
[3] 邓思宇,卢茜,郄淑燕,等.等速测试指标与改良Ashworth量表用于踝痉挛评定的相关性研究[J]. 中国康复理论与实践, 2016, 22(2):178-183.
[4] Dos SAN, Rocha NACF.Immediate effect of kinesio taping on knee extensor torque of children with cerebral palsy: three case reports[J]. NeuroRehabilitation, 2018, 43(4): 519-523.
[5] 陈明珍,姜凡,单永,等.多模态超声成像在脑卒中患者腓肠肌痉挛评估中的应用[J].中国康复理论与实践,2021,27(7):791-796.
[6] 樊留博,韩文胜,江莹莹,等.超声弹性成像评价脑卒中偏瘫肢体硬度对痉挛性偏瘫患者预后的影响[J].中华全科医学,2017,15(8):1323-1325,1354.
[7] 郭云怀,马力,高博,等.实时剪切波弹性成像技术检测下肢腓肠肌的影响因素分析[J].中国医学创新,2018,15(4):15-18.
[8] 蔡兴文,任军,肖慧敏,等. 剪切波弹性成像评估脑卒中肢体肌力变化及预后的应用价值[J]. 临床超声医学杂志,2021,23(1):49-52.
[9] 严晓岚,谢洁珊,金炳旭,等. 穴位注射联合作业疗法对痉挛型脑瘫患儿腕关节背伸能力的影响[J]. 按摩与康复医学,2021,12(4):44-46.
[10] Wu SM, Wu B, Liu M, et al.Stroke in China: advances and challenges in epidemiology, prevention, and management[J].Lancet Neurol, 2019, 18(4): 394-405.
[11] 张京,肖娟,杨远滨. 肌肉结构参数模型在中枢神经系统所致肌张力异常评价中的作用和分析[J]. 中国康复医学杂志, 2015,30(4):408-411.
[12] 王晓慧,张宇虹,苏本利. 高频超声检测2型糖尿病周围神经病变患者足部肌肉萎缩[J]. 中国医学影像技术,2013,29(2):276-279.
[13] Trompetto C, Marinelli L, Mori L, et al.Pathophysiology of spasticity: implications for neurorehabilitation[J]. Biomed Res Int, 2014, 2014: 354906.
[14] 黄馨云,吴梦蝶,姜淑云,等. 脑卒中后上肢痉挛性瘫痪客观评定方法的研究进展[J]. 中国康复医学杂志,2018,33(12):1473-1478.
[15] 杨翠花,马慧,张广飞. 针灸联合经皮神经电刺激对脑卒中后腓肠肌痉挛患者日常生活能力及生活质量的影响[J]. 检验医学与临床,2023,20(16):2445-2449.
[16] 程杨杨,王涌,蔡叶华,等. 剪切波弹性成像技术对脑卒中偏瘫患者肌张力和肌肉硬度的评估价值研究[J]. 现代生物医学进展,2022,22(7):1239-1242.
[17] Yoshikawa M, Ishikawa T, Ohno E, et al.Variability measurements provide additional value to shear wave elastography in the diagnosis of pancreatic cancer[J]. Sci Rep, 2021, 11(1): 7409.
[18] Gao J, He W, Du LJ, et al.Ultrasound strain elastography in assessment of resting biceps brachii muscle stiffness in patients with Parkinson’s disease: a primary observation[J].Clin Imaging, 2016, 40(3): 440-444.
[19] Du LJ, He W, Cheng LG, et al.Ultrasound shear wave elastography in assessment of muscle stiffness in patients with Parkinson’s disease:aprimary observation[J]. Clin Imag, 2016, 40(6): 1075-1080.
[20] Koo TK, Guo JY, Cohen JH, et al.Relationship between shear elastic modulus and passive muscle force: an ex-vivo study[J]. J Biomech, 2013, 46(12): 2053-2059.
[21] 田第娇,万兵,刘玥,等. IVIM成像技术评估骨骼肌生理和病理状态的应用进展[J]. 磁共振成像,2024,15(10):222-227.
[22] 蒋明霞,陈轩静,胡锦荣,等. 超声剪切波弹性成像对脑卒中患者腓肠肌硬度变化的定量评估[J]. 数理医药学杂志,2019,32(9):1283-1285.
