剪切波声弹性成像仪对人体足三里穴位定位及紧张度观察

目的 探讨高频超声成像技术用于中医针灸足三里穴位实时定位及剪切波弹性成像(SWE)技术用于足三里穴位肌张力测定的意义.方法 使用法国Supersonic Imagine公司的AixPlorer型高帧频实时定量SWE诊断仪,将L4-15线阵探头置于足三里穴位断面,豪针在高频起声引导下依据经穴断面解剖图谱为精确定位;启动SWE模式记录组织弹性图,使用其定量分析系统Q-BOX,取样区为直径3、8和12 mm的同心圆,测量进针前、进针后及脉冲电刺激时足三里穴位的杨氏模量值.结果Q-BOX取样区直径为3 mm时,进针前、进针后及电刺激时穴位杨氏模量平均值分别为(12.61±6.27)、(24.00±11.94)和(111.48±52.81)kPa; Q-BOX取样区直径为8mm时,进针前、进针后及电刺激时穴位杨氏模量平均值分别为(15.85±5.93)、(25.72±13.63)和(84.84±49.60) kPa;Q-BOX取样区直径为12 mm时,进针前、进针后及电刺激时穴位杨氏模量平均值分别为(17.75±6.72)、(24.92±11.50)和(70.75±42.20) kPa.在不同直径组中,进针前与进针后、进针前与电刺激时的穴位杨氏模量比较,差异有显著统计学意义(P＜0.01).结论 与以往尸体经穴断面解剖定位不同,高频超声引导豪针对活体经穴断面解剖精确定位,具有精准、直观、动态和简廉的特点,故具临床实用价值.SWE技术用于足三里穴位肌张力无创测定为中医针灸穴位“得气”研究提供了一种新手段.

Application of shear wave elastograpgy in measurement of muscle tension and localization of Zusanli acupoint in human being

Objective To evaluate the value of shear-wave elastograpgy（SWE ） in the measurement of muscle tension of Zusanli（ST36 ） acupoint and high-frequency ultrasound in the localization of Zusanli acupoint.Methods The muscle tension of Zusanli acupoint was measured and recorded by a real-time SWE instrument（AixPlorer ） produced by France Supersonic Imagine before acupuncture,during acupuncture and during electroacupuncture.The results were compared.The Zusanli acupoint was pinpointed by high-frequency ultrasound according to anatomy atlas of meridian acupoints section.Results The average value of Young’s modulus in Zusanli acupoint before acupuncture,during acupuncture and during electroacupuncture was（12.61±6.27 ） kPa,（24.00±11.94） kPa,and（111.48±52.81 ） kPa when the diameter of sampling was 3 mm in the quantity analysis system of SWE. The average value of Young’s modulus in Zusanli acupoint before acupuncture,during acupuncture and during electroacupuncture was（15.85±5.93 ） kPa,（25.72±13.63 ） kPa,and（84.84±49.60 ） kPa when the diameter of sample was 8 mm.The average value of Young’s modulus in the spots of acupoint Zusanli during the ahead of acupuncture,acupuncture and electroacupuncture was（17.75±6.72 ） kPa,（24.92±11.50 ） kPa,and（70.75±42.20 ） kPa when the diameter of sampling was 12 mm.The average value of Young’s modulus in Zusanli acupoint during acupuncture was significantly higher than that before acupuncture（P〈0.01 ） when the diameter of sampling was 3 mm,8 mm and 12 mm.The average value of Young’s modulus in Zusanli acupoint during electroacupuncture and during electroacupuncture was significantly higher than that before acupuncture（P〈0.01 ） when the diameter of sampling was 3 mm,8 mm and 12 mm.Conclusion The method by high-frequency ultrasound of localization meridian acupoints different from meridian acupoints section in corpse is accurate,direct,dynamic,simple and cheap,which overcomes the limitation of CT and MRI.The muscular tensity of Zusanli acupoint measured by SWE during acupuncture and electroacupuncture is one of the new reference indices that can be used forjudging the degree of qi arrival.