Shao Yu-Hong, Peng Ze, Kong Xun, Wang Bin, Zhang Hui
Department of Ultrasound, Peking University First Hospital, Beijing, 100034, China.
J Ultrasound Med. 2019 Mar;38(3):713-723. doi: 10.1002/jum.14755. Epub 2018 Oct 2.
This study aims to evaluate the Achilles tendon's properties after rehabilitation training in patients with stroke using real-time ultrasound elastography.
A total of 24 patients with mild hemiplegic stroke in the past 6 to 12 months and unilateral lower limb movement disorder were prospectively enrolled. All patients accepted 9-week rehabilitation training with the same schema. The 2-dimensional elastography and real-time elastography findings in the impaired and contralateral normal Achilles tendon were measured at pretraining and at 3, 6, and 9 weeks after training, which included tendon length, thickness, elasticity score (grade 1-3), and strain ratio of fat to tendon. The functional properties, which include the 10-meter walk test and timed up-and-go scores, were evaluated before and after the 9-week training.
The impaired Achilles tendon had a longer length (P = .002), lower frequency of grade 1 (P = .012), and lower strain ratio (P = .009) than the contralateral tendon before training. The impaired tendons at the third, sixth, and ninth weeks after training were compared to ones before training, respectively, which revealed shorter length, increased frequency of grade 1, and increased strain ratio. The first statistically significant changes in the length were observed at the sixth week, while such changes in elasticity score and strain ratio were observed at the ninth week.
Two-dimensional elastography and real-time elastography can provide valuable imaging markers for quantitatively evaluating the Achilles tendon's properties after rehabilitation training in patients with stroke.
本研究旨在使用实时超声弹性成像评估中风患者康复训练后跟腱的特性。
前瞻性纳入24例在过去6至12个月内患有轻度偏瘫性中风且单侧下肢运动障碍的患者。所有患者均接受了为期9周的相同方案的康复训练。在训练前以及训练后3周、6周和9周测量患侧和对侧正常跟腱的二维弹性成像和实时弹性成像结果，包括肌腱长度、厚度、弹性评分（1 - 3级）以及脂肪与肌腱的应变比。在9周训练前后评估功能特性，包括10米步行测试和计时起立行走评分。
训练前，患侧跟腱比健侧跟腱更长（P = 0.002），1级频率更低（P = 0.012），应变比更低（P = 0.009）。分别将训练后第3周、第6周和第9周的患侧肌腱与训练前的进行比较，结果显示长度缩短、1级频率增加以及应变比增加。长度的首次统计学显著变化在第6周观察到，而弹性评分和应变比的此类变化在第9周观察到。
二维弹性成像和实时弹性成像可为定量评估中风患者康复训练后跟腱的特性提供有价值的成像标志物。
