| 摘要: |
| 目的：探讨超声定量参数在评估脑卒中下肢肌肉痉挛瘫痪患者肌肉注射A型肉毒毒素疗效中的价值。方法：纳入脑卒中下肢肌肉痉挛行A型肉毒毒素注射治疗患者22例作为研究对象，同期选取20例成年健康者作为对照组。在卒中患者行肉毒毒素治疗前、治疗后1周、治疗后4周分别进行超声定量参数评估，包括平均灰度值（mean grey value，MGV）、肌肉厚度、肌束长度、羽状角及剪切波弹性测量，同时对其采用Brunnstrom分期和改良Ashworth量表（Modified Ashworth Scale，MAS）进行临床评估。比较卒中组与健康组下肢痉挛肌肉的超声定量参数的差异以及卒中组肉毒毒素治疗前后的变化，分析超声定量参数和临床评估量表之间的关系。结果:卒中组腓肠肌内侧头的厚度和肌束长度较健康组减小，腓肠肌内侧头和比目鱼肌的MGV和杨氏模量值均显著高于健康组，差异有统计学意义（P＜0.05）。卒中患者腓肠肌内侧头和比目鱼肌的杨氏模量值在肉毒毒素治疗前后有显著性差异，治疗后1周和4周均较治疗前减小（P＜0.05）。卒中患者的腓肠肌内侧头杨氏模量值和MAS评分呈正相关（相关系数r=0.519, P＜0.05），MGV与治疗反应呈正相关（相关系数r=0.435, P＜0.05）。结论：超声定量参数可以提供卒中后痉挛肌肉的相关信息，可作为肌肉注射肉毒毒素治疗前后的评估与随访手段，为调整肉毒毒素剂量提供一定客观依据。 |
| 关键词: 超声 卒中 肌痉挛 A型肉毒毒素 |
| DOI： |
| 投稿时间：2024-05-29修订日期：2024-07-21 |
| 基金项目: |
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| Quantitative evaluation of lower limb muscles in stroke survivors with Botulinum Toxin Type A Injection using ultrasound |
| shuhua,yaoqiyu,yexinhua,liao |
| (The First Affiliated Hospital of Nanjing Medical University;Department of Ultrasound, Nanjing Drum Tower Hospital) |
| Abstract: |
| Objective: To investigate the effectiveness of botulinum toxin A (BTA) injection in lower extremities spastic muscles in stroke patients by quantitative ultrasound. Methods: A total of 22 adult stroke patients with lower limb spasm were included in the study and 20 adult healthy subjects as control group. The quantitative assessment of ultrasound was performed at preintervention, at 1-week postintervention and at 4-week postintervention., including mean grey value, (MGV), muscle thickness, fascicle length, pennate angle and shear wave elasticity (SWE) as well as clinical assessment including Brunnstrom staging and MAS. The difference of ultrasonic quantitative parameters of muscles between stroke group and healthy group and the changes of spastic muscles in stroke patients before and after botulinum toxin injection treatment were compared. The relationship between quantitative parameters of ultrasound and clinical evaluation scales was analyzed.Results: Muscle thickness and fascicle length of medial gastrocnemius (MG) in stroke group were significantly decreased than those in healthy group. The MGV and Young’s modulus of MG and soleus (SL) in stroke group were significantly increased compared with those in healthy group (P ＜ 0.05). After 1 week and 4 weeks of treatment compared with the baseline values, significant improvement was observed in Young’s modulus of MG and SL (P ＜ 0.05). Positive correlation was observed between The Young’s modulus of MG with MAS score in stroke patients(r=0.519, P ＜ 0.05). The value of MGV was positively correlated with the efficiency of treatment(r=0.435, P ＜ 0.05).Conclusion: Quantitative ultrasound can provide information about spastic muscles after stroke and is a promising diagnostic tool for evaluation and follow-up in spastic muscles after BTA injection treatment |
| Key words: ultrasound, stoke, spastic muscle, botulinum toxin A injection |
