声触诊组织量化成像评价注射A型肉毒毒素治疗脑卒中后前臂旋前肌痉挛肌肉硬度改变

目的 探讨声触诊组织量化成像（VTIQ）评价注射A型肉毒毒素治疗脑卒中后前臂旋前肌痉挛肌肉硬度改变的价值。方法 收集31例脑卒中后前臂旋前肌痉挛患者，在其松弛状态下，于超声引导注射A型肉毒毒素，并于治疗前和治疗后1个月对双侧旋前圆肌、旋前方肌行VTIQ检查，测量剪切波速度（SWV），对比治疗前后以及患侧与健侧SWV差异。于治疗前后对患侧上肢肌力进行改良Ashworth量表（MAS）评分并比较其差异，评价其与SWV的相关性。结果 治疗前患侧旋前圆肌SWV值高于健侧（P=0.005）；治疗后1个月，患侧旋前圆肌、旋前方肌SWV值与健侧比较差异均无统计学意义（P均>0.05）。治疗后患侧旋前圆肌、旋前方肌SWV值均小于治疗前（P均<0.05），治疗前后患侧上肢MAS评分差异有统计学意义（Z=-2.252，P=0.024）。治疗前后患侧上肢肌张力MAS评分与治疗前后患侧旋前圆肌的SWV值呈正相关（r_s=0.629、0.653，P均<0.001）。结论 VTIQ可用于动态观察脑卒中后前臂旋前肌痉挛患者旋前圆肌、旋前方肌的肌肉硬度，由此定量评估注射A型肉毒毒素治疗脑卒中后前臂旋前肌痉挛的疗效。

Virtual touch tissue imaging quantification technique in evaluation of skeletal muscle hardness after injection of botulinum toxin type A for treatment of forearm pronation muscle spasm after stroke

Objective To explore the value of virtual touch tissue imaging quantification (VTIQ) in evaluation on skeletal muscle hardness after injection of botulinum toxin type A for treatment of forearm pronation muscle spasm after stroke. Methods A total of 31 patients with forearm pronation muscle spasm after stroke were collected. VTIQ examinations were performed on bilateral pronator teres and pronator quadratus before and 1 month after ultrasound-guided injection of botulinum toxin type A. Shear wave velocity (SWV) was measured, and the differences between the affected side and the healthy side were compared before and after the treatment. The modified Ashworth scale (MAS) was used to evaluate the muscle tension of upper limb on the affected side before and after treatment, and the differences were compared, and the correlation with SWV was evaluated. Results SWV of pronator teres of the affected side was higher than that of the healthy side before treatment (P=0.005). One month after treatment, there was no significant difference in SWV of the pronator teres and pronator quadratus between the affected side and healthy side (both P>0.05). SWV of the pronator teres and pronator quadratus on the affected side were lower after treatment than those before treatment (both P<0.05). The difference of MAS score of the affected upper limb before and after treatment were statistically significant (Z=-2.252, P=0.024). MAS score of upper limb on the affected side was positively correlated with SWV of the pronator teres on the affected side before and after treatment (r_s=0.629, 0.653, both P<0.001). Conclusion VTIQ can be used to dynamically observe muscle hardness of pronator teres and pronator quadratus in patients with spasm of forearm pronator after stroke, and quantitatively evaluate the curative effect of injection of botulinum toxin type A for treatment of forearm pronator muscle spasm after stroke.