Wu Chueh-Hung, Ho Yu-Chun, Hsiao Ming-Yen, Chen Wen-Shiang, Wang Tyng-Guey
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
Ultrasound Med Biol. 2017 Jun;43(6):1105-1111. doi: 10.1016/j.ultrasmedbio.2016.12.008. Epub 2017 Mar 9.
Current clinical evaluations of post-stroke upper limb spasticity are subjective and qualitative. We proposed a quantitative measurement of post-stroke spastic muscle stiffness by using shear-wave ultrasound elastography and tested its reliability. Acoustic radiation force impulse with shear wave velocity (SWV) detection was used to evaluate stiffness of the biceps brachii muscles at 90° and 0° elbow flexion. In 21 control subjects, SWV did not significantly differ between dominant and non-dominant sides at either flexion angle (0°: p = 0.311, 90°: p = 0.436). In 31 patients who had recent stroke, SWV was significantly greater on the paretic side than on the non-paretic side at both 90° (2.23 ± 0.15 m/s vs. 1.88 ± 0.08 m/s, p = 0.036) and 0° (3.28 ± 0.11 m/s vs. 2.93 ± 0.06 m/s, p = 0.002). The physical appearance of arms and forearms of our patients and controls prevented blinding of the rater to paretic or non-paretic side. At 90°, SWV on the paretic side correlated positively with modified Ashworth scale and modified Tardieu scale (spasticity severity) and negatively with Stroke Rehabilitation Assessment of Movement score (motor function impairment). The intra-class correlation coefficients of intra-rater and inter-rater reliability for SWV measurements were classified as excellent. In conclusion, high SWV was associated with high spasticity and poor function of the post-stroke upper limb, suggesting possible use as a reliable quantitative measure for disease progression and treatment follow-up.
目前对中风后上肢痉挛的临床评估是主观且定性的。我们提出通过剪切波超声弹性成像对中风后痉挛肌肉的僵硬度进行定量测量，并测试其可靠性。采用具有剪切波速度（SWV）检测功能的声辐射力脉冲来评估肱二头肌在肘部屈曲90°和0°时的僵硬度。在21名对照受试者中，两个屈曲角度下优势侧和非优势侧的SWV均无显著差异（0°：p = 0.311，90°：p = 0.436）。在31名近期中风患者中，90°（2.23±0.15 m/s对1.88±0.08 m/s，p = 0.036）和0°（3.28±0.11 m/s对2.93±0.06 m/s，p = 0.002）时患侧的SWV均显著高于健侧。我们的患者和对照受试者的手臂及前臂外观使得评估者无法对患侧或健侧进行盲法判断。在90°时，患侧的SWV与改良Ashworth量表和改良Tardieu量表（痉挛严重程度）呈正相关，与运动中风康复评估评分（运动功能障碍）呈负相关。SWV测量的评分者内和评分者间可靠性的组内相关系数被归类为优秀。总之，高SWV与中风后上肢的高痉挛程度和功能不良相关，提示其可能作为疾病进展和治疗随访的可靠定量指标。
