Department of Radiology, Malatya Training and Research Hospital, Turgut Özal Bulvarı No. 4, 44090, Yeşilyurt, Malatya, Turkey.
Faculty of Medicine, Department of Radiology, Gazi University, Mevlana Bulvarı No. 29, 06560, Yenimahalle, Ankara, Turkey.
J Med Ultrason (2001). 2020 Oct;47(4):609-615. doi: 10.1007/s10396-020-01042-6. Epub 2020 Jul 24.
The first aim of this study was to evaluate changes in the stiffness of the medial gastrocnemius muscle (GM) after a botulinum toxin A (BoNT-A) injection in children with cerebral palsy (CP) using shear wave elastography (SWE). We also wanted to investigate the usability of SWE for evaluating spasticity in a clinical setting. The second aim of this study was to show how treatment of the gastrocnemius muscle spasticity caused a change in the elasticity of the anterior tibial (TA) muscle.
Twenty-four pediatric patients diagnosed with a spastic type of CP, who were scheduled to receive a BoNT-A injection in the gastrocnemius muscle, were included in the study. There was a total of 43 lower extremities to evaluate, and muscle stiffness was measured before the injection and a month post injection using SWE. The physiatrist evaluated muscle spasticity using the Modified Ashworth Scale (MAS) and the Modified Tardieu Scale at about the same time.
SWE values of the GM (pre-BoNT-A: 45.9 ± 6.5 kPa, post-BoNT-A: 25.0 ± 5.7 kPa) decreased significantly post BoNT-A injection (P < 0.01). SWE measurements of the GM had positive correlations with MAS, V1X, V3X, and R2-R1 (P < 0.01); and negative correlations with R2 and R1 (P < 0.05). SWE values of the TA muscle (pre: 36.9 ± 7.9 kPa, post: 28.4 ± 5.2 kPa) decreased significantly (P < 0.01).
Quantitative measurement of muscle stiffness using SWE may provide important information for the evaluation of spasticity and treatment efficiency in pediatric CP patients.
本研究的首要目的是使用剪切波弹性成像（SWE）评估脑瘫（CP）患儿肉毒毒素 A（BoNT-A）注射后内侧腓肠肌（GM）硬度的变化。我们还希望研究 SWE 在临床环境中评估痉挛的可用性。本研究的第二个目的是展示治疗比目鱼肌痉挛如何引起胫骨前肌（TA）弹性的变化。
本研究纳入了 24 例拟接受 GM 肉毒毒素 A 注射的痉挛型 CP 儿科患者。共有 43 条下肢进行评估，在注射前和注射后 1 个月使用 SWE 测量肌肉硬度。物理治疗师使用改良 Ashworth 量表（MAS）和改良 Tardieu 量表在大致相同的时间评估肌肉痉挛。
GM 的 SWE 值（BoNT-A 前：45.9±6.5 kPa，BoNT-A 后：25.0±5.7 kPa）在 BoNT-A 注射后显著降低（P<0.01）。GM 的 SWE 测量值与 MAS、V1X、V3X 和 R2-R1 呈正相关（P<0.01）；与 R2 和 R1 呈负相关（P<0.05）。TA 肌肉的 SWE 值（BoNT-A 前：36.9±7.9 kPa，BoNT-A 后：28.4±5.2 kPa）显著降低（P<0.01）。
使用 SWE 定量测量肌肉硬度可能为评估儿科 CP 患者的痉挛和治疗效果提供重要信息。
