基于剪切波弹性成像技术在针刺脑卒中后上肢肌痉挛疗效评估中的应用

Application of shear wave elastography in evaluating the therapeutic effect of acupuncture on upper limb muscle spasticity after stroke

摘要

目的 探究剪切波弹性超声成像（SWE）对针刺治疗脑卒中肌痉挛疗效的临床效用。方法 选取2024年4月至12月符合标准的100例脑卒中肌痉挛患者（黑龙江中医药大学附属第一医院）按随机数字表法分为对照组（50例，口服药物治疗+蜡疗）及试验组（50例，联合局部拮抗肌针刺法）。在治疗前后基于SWE对患者患侧上肢肌肉（肱二头肌、肱肌、肱桡肌）进行杨氏模量平均值（E_mean）和剪切波速度（Vs）的测量，并以改良Ashworth量表（MAS）和Barthel指数（BI）进行评估。结果 两组患者患侧的上肢肌肉的E_mean和Vs治疗后较治疗前降低（P<0.01），试验组患侧肱二头肌和肱肌的E_mean和Vs较对照组下降更显著（P<0.05），肱桡肌的E_mean和Vs组间差异无统计学意义（P>0.05）；两组MAS评分治疗后较治疗前降低（P<0.01），试验组降幅更显著（P<0.05）；BI指数较治疗前均升高（P<0.01），试验组较对照组升高显著（P<0.05）。结论 SWE可通过定量肌肉硬度变化，客观评估针刺治疗脑卒中后上肢肌痉挛的疗效，为临床提供无创、精准的评估方法。

Abstract

Objective To investigate the diagnostic value of shear wave elastography (SWE) in evaluating the efficacy of acupuncture for post-stroke muscle spasticity. Methods Between April and December 2024, 100 stroke patients with muscular spasm meeting the eligibility criteria were recruited from the First Affiliated Hospital of Heilongjiang University of Chinese Medicine. Participants were allocated to the control group (50 cases, receiving oral pharmacotherapy combined with wax therapy) or the experimental group (50 cases, administered with local antagonist muscle acupuncture in conjunction with conventional therapy) using the random number table technique. Before and after treatment, SWE was used to measure the Young’s modulus mean value (E_mean) and shear wave velocity (Vs) of the affected upper limb muscles (biceps brachii, brachialis, and brachioradialis). Clinical assessments included the Modified Ashworth Scale (MAS) and Barthel Index (BI). Results Post-treatment analysis revealed that E_mean and Vs in the affected upper limb muscles were significantly lower in both groups (P<0.01). Compared with the control group, the experimental group demonstrated a more substantial decline in E_mean and Vs parameters for the biceps brachii-brachialis complex (P<0.05). However, the brachioradialis showed no significant differences between groups (P>0.05). The MAS scores decreased post-treatment in both groups (P<0.01), with a more pronounced reduction in the experimental group (P<0.05). The BI scores increased in both groups (P<0.01), with a greater improvement in the experimental group (P<0.05). Conclusion SWE can quantitatively assess changes in muscle stiffness, providing an objective, non-invasive, and precise method for evaluating the therapeutic effect of acupuncture on post-stroke upper limb spasticity.

关键词

剪切波弹性超声成像 / 脑卒中后肌痉挛 / 杨氏模量 / 改良Ashworth量表 / Barthel指数

Key words

shear wave elastography / post-stroke muscle spasticity / young’s modulus / modified ashworth Scale / barthel index

参考文献

[1] Murphy SJX, Werring DJ. Stroke: causes and clinical features[J]. Medicine, 2020, 48(9): 561-566.

[2] Smania N, Picelli A, Munari D, et al. Rehabilitation procedures in the management of spasticity[J]. Eur J Phys Rehabil Med, 2010, 46(3): 423-438.

[3] GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Neurol, 2021, 20(10): 795-814.

[4] 张心培, 刘楠, 周谋望. 肌张力评定方法的研究进展[J]. 中国康复医学杂志, 2021, 36(7): 873-880.

[5] Zúñiga LDO, López CAG, González ER. Ultrasound elastography in the assessment of the stiffness of spastic muscles: a systematic review[J]. Ultrasound Med Biol, 2021, 47(6): 1448-1464.

[6] 李良芳, 朱俊志, 欧海宁, 等. 剪切波弹性成像超声在脑卒中偏瘫上肢痉挛定量评估中的应用[J]. 中国康复医学杂志, 2022, 37(1): 75-78.

[7] 国家卫生健康委脑卒中防治工程委员会. 中国脑卒中防治指导规范(2021年版)[R]. 北京: 国家卫生健康委办公厅, 2021.

[8] 国家中医药管理局脑病急症协作组. 中风病诊断与疗效评定标准[J]. 北京中医药大学学报, 1996, 19(1): 55-56.

[9] 刘悦, 苏美銮, 刘雅玲. 针刺拮抗肌群对脑卒中后上肢痉挛的效果[J]. 中国康复理论与实践, 2015, 21(5): 579-582.

[10] Bohannon RW, Smith MB. Interrater reliability of a modified ashworth scale of muscle spasticity[J]. Phys Ther, 1987, 67(2): 206-207.

[11] 李奎成, 唐丹, 刘晓艳, 等. 国内Barthel指数和改良Barthel指数应用的回顾性研究[J]. 中国康复医学杂志, 2009, 24(8): 737-740.

[12] 孙振球, 徐勇勇. 医学统计学[M]. 第8版. 北京: 人民卫生出版社, 2020: 45-78.

[13] Sáinz-Pelayo MP, Albu S, Murillo N, et al. Spasticity in neurological pathologies. an update on the pathophysiological mechanisms, advances in diagnosis and treatment[J]. Rev Neurol, 2020, 70(12): 453-460.

[14] 周吴, 王凤怡, 陈佳佳, 等. 脑卒中后肌痉挛评估方法概述[J]. 中国循证医学杂志, 2024, 24(6): 739-744.

[15] Liu J, Pan H, Bao Y, et al. The value of real-time shear wave elastography before and after rehabilitation of upper limb spasm in stroke patients[J]. Biomed Res Int, 2020, 2020: 6472456.

[16] 杨凤秋, 王丹, 刘署鹏, 等. 剪切波弹性成像评估针刺穴位治疗脑卒中后肌痉挛的研究[J]. 影像研究与医学应用, 2023, 7(18): 48-50.

[17] Coskun M, Sendur HN, Cerit MN, et al. Assessment of forearm muscles with ultrasound shear wave elastography in patients with acromegaly[J]. Pituitary, 2023, 26(6): 716-724.

[18] 毕胜, 许云影. 偏瘫上肢痉挛、联合反应与异常协同运动临床相关研究[J]. 中国康复医学杂志, 2008, 23(11): 1007-1009.

基金资助

黑龙江省中医药科研项目(ZHY-2022-151)