Yang Yuan-Bin, Zhang Jing, Leng Zhen-Peng, Chen Xin, Song Wei-Qun
Department of rehabilitation medicine, Xuanwu Hospital, Capital Medical University Beijing 100053, P. R. China.
Beijing Shijitan Hospital, Capital Medical University Beijing 100038, P. R. China.
Int J Clin Exp Med. 2014 Sep 15;7(9):2712-7. eCollection 2014.
This study aims to compare the difference and the change trend of Muscle Architecture Parameters (MAP) between spastic and normal muscle tone patients after stroke, and analysis the application and value of Muscle Architecture Parameters in evaluating spasticity after stroke.
41 stroke patients were divided into spastic group (26 cases), normal muscle tone control group (15 cases). Modified Ashworth Scale (MAS) was applied in both groups for assessing muscle tone of lower limbs (no influence, contralateral). Muscle architectural parameters of ultrasound measurement include muscle thickness, fascicle length and pennation angle. The difference of three muscle architectural parameters between the affected side and the contralateral side in spastic group and the difference of MAS and three muscle architectural parameters between spastic group and normal control group were compared.
MAS score, Pennation Angle (PA) and Muscular Thickness (MT) value of MAP in spastic group were significantly higher than the control group, Fascicle length (FL) is significantly lower than the control group (P < 0.05). In spastic group, MAS score, PA and MT value of MAP of affected side muscle was substantially higher than that of contralateral, FL value significantly lower than that of contralateral (P < 0.05). There was positive correlation between MAS and PA and MT but was negative correlation between MAS and FL, rank correlation coefficient test was statistical significant (p < 0.05). Logistic multivariate regression analysis showed that spasticity can lead PA and FL to change (p < 0.05), there is no clear correlation between MT and spasticity occurs (P > 0.05).
MAP has a better sensitivity in evaluating muscle tone between spastic patients and non-spastic patients, and degrees of spasticity have a clear corresponding exponential relationship to MAP. Combing MAS and MAP can assess muscle tone more objectively and accurately because subtle changes can be observed by testing values of architecture parameters that compensating for the shortcomings of MAS in reliability and validity. Thus it is helpful for guiding clinical antispastic practice.
本研究旨在比较脑卒中后痉挛性和正常肌张力患者肌肉结构参数（MAP）的差异及变化趋势，分析肌肉结构参数在评估脑卒中后痉挛中的应用及价值。
将41例脑卒中患者分为痉挛组（26例）、正常肌张力对照组（15例）。两组均采用改良Ashworth量表（MAS）评估下肢肌张力（健侧无影响）。超声测量的肌肉结构参数包括肌肉厚度、肌束长度和羽状角。比较痉挛组患侧与健侧三项肌肉结构参数的差异，以及痉挛组与正常对照组MAS和三项肌肉结构参数的差异。
痉挛组MAS评分、MAP的羽状角（PA）和肌肉厚度（MT）值显著高于对照组，肌束长度（FL）显著低于对照组（P<0.05）。痉挛组患侧肌肉的MAS评分、PA和MT值明显高于健侧，FL值明显低于健侧（P<0.05）。MAS与PA和MT呈正相关，与FL呈负相关，等级相关系数检验有统计学意义（p<0.05）。Logistic多因素回归分析显示，痉挛可导致PA和FL发生变化（p<0.05），MT与痉挛发生无明显相关性（P>0.05）。
MAP在评估痉挛患者与非痉挛患者肌张力方面具有较好的敏感性，痉挛程度与MAP有明确的对应指数关系。结合MAS和MAP可以更客观准确地评估肌张力，因为通过检测结构参数值可以观察到细微变化，弥补了MAS在可靠性和有效性方面的不足。因此有助于指导临床抗痉挛实践。
