超声成像技术在痉挛型脑性瘫痪患儿腓肠肌定量评定中的应用

目的 探讨临床应用超声弹性成像定量评估痉挛型脑瘫患儿腓肠肌的形态结构及生物力学特性的可行性。 方法 2020年12月至2021年12月,选取深圳市儿童医院康复医学科治疗的痉挛型脑瘫(偏瘫或双瘫)患儿36例为试验组,同期招募年龄、性别匹配的健康儿童30例为对照组。二维灰阶高频超声及剪切弹性成像检查试验组偏瘫侧或肌张力较高一侧、对照组随机一侧的腓肠肌内侧头,记录肌肉厚度(MT)、肌纤维长度(FL)、羽状角(PA)和剪切波速度(SWV)。采用改良Ashworth量表(MAS)和粗大运动功能测试(GMFM)评估试验组腓肠肌肌张力和粗大运动功能。 结果 试验组腓肠肌内侧头MT、FL显著小于对照组(|t| > 3.937,P < 0.001),PA、SWV显著大于对照组(|t| > 6.105,P < 0.001)。试验组MT、FL与GMFM评分呈正相关(r > 0.391, P < 0.05),SWV与MAS评分呈正相关(r = 0.734, P < 0.001)。 结论 超声成像可用于量化评估痉挛型脑瘫患儿腓肠肌的形态和硬度。

Application of ultrasonography in quantitative evaluation of gastrocnemius muscles in children with spastic cerebral palsy

Objective To apply ultrasonography to quantitatively evaluate the structure and biomechanical properties of gastrocnemius muscle in children with spastic cerebral palsy. Methods From December, 2020 to December, 2021, 36 children with spastic diplegia or hemiplegia were selected as experimental group, and other 30 healthy children matched age and gender were as control group during the same period. All the subjects were measured muscle thickness (MT), muscle fiber length (FL), pinnate angle (PA) and shear wave velocity (SWV) with two-dimensional ultrasound imaging and shear wave elastography on the medial gastrocnemius of the affected side (hemiplegia), more serious side (diplegia) or random side (control group), while the gastrocnemius muscle tone and gross motor function of the experimental group were assessed with modified Ashworth Scale (MAS) and Gross Motor Function Measure (GMFM). Results MT and FL were less in the experimental group than in the control group (|t| > 3.937, P< 0.001), while PA and SWV were more (|t| > 6.105, P < 0.001). MT and FL positively correlated to GMFM score (r > 0.391, P < 0.05), while SWV positively correlated to MAS score (r= 0.734, P < 0.001). Conclusion Ultrasonography can be used to quantitatively evaluate the structure and stiffness of gastrocnemius muscle for children with spastic cerebral palsy.