Gao Shiai, Yu Zifu, Liu Xihua
School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
Shandong Provincial Center for Disease Control and Prevention, Jinan, China.
Front Neurol. 2025 Aug 20;16:1634382. doi: 10.3389/fneur.2025.1634382. eCollection 2025.
To investigate the correlation between lower limb spasticity and proprioception in stroke patients, to analyze the influencing factors of spasticity, and to evaluate the predictive value of musculoskeletal ultrasound parameters on spasticity.
A cross-sectional study was used to enroll 80 stroke patients admitted to the Rehabilitation Center of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from October 2024 to April 2025. The degree of lower limb spasticity was evaluated by the modified Ashworth Scale (MAS), and the proprioceptive assessment module of the Pro-kin balance system was used to quantitatively detect the mean trajectory error (ATE) and the average weight-bearing asymmetry (AWA). Musculoskeletal ultrasound was used to detect the spasmodic side and the healthy gastrocnemius muscle, and the longitudinal and transverse ultrasound images were obtained, and the length of muscle fibers, medial head pinnate angle and muscle thickness were measured. Spearman correlation analysis was used to explore the correlation between MAS score and various parameters, a multiple linear regression model was constructed to analyze the influencing factors of spasticity, and the predictive performance of ultrasound parameters was evaluated by receiver operating characteristic (ROC) curve.
Compared with the healthy side, the muscle fiber length, medial head pinnate angle and muscle thickness of the gastrocnemius muscle on the spasticity side were significantly reduced ( < 0.05). The mean trajectory difference of proprioceptive parameters was (65.83 ± 13.11) %, and the average weight-bearing force difference was (2.41 ± 0.46) kg. Correlation analysis showed that MAS spasticity score was statistically significantly related to proprioceptive parameters and muscle structure parameters ( < 0.05), and multiple linear regression analysis showed that muscle feather angle ( = 0.362), muscle fiber length ( = -0.157), muscle thickness ( = -0.230), mean trajectory error ( = 0.329) and average weight-bearing strength difference ( = 0.260) constituted independent influencing factors for MAS score (adjusted = 0.787, <0.05). ROC curve analysis showed that the area under the curve of muscle pinnate angle predicting spasticity (MAS ≥ 2 grade) was the largest (AUC = 0.850, 95%CI: 0.729-0.972), which was better than muscle fiber length (AUC = 0. 840) and muscle thickness (AUC = 0.838).
There is a significant correlation between lower limb spasticity and proprioceptive and muscle structure parameters in stroke patients, and proprioception and muscle structure parameters are the key factors affecting spasticity, and musculoskeletal ultrasound can be used as a quantitative evaluation tool for lower limb spasticity in stroke.
探讨脑卒中患者下肢痉挛与本体感觉之间的相关性，分析痉挛的影响因素，并评估肌肉骨骼超声参数对痉挛的预测价值。
采用横断面研究方法，选取2024年10月至2025年4月在山东中医药大学附属医院康复中心收治的80例脑卒中患者。采用改良Ashworth量表（MAS）评估下肢痉挛程度，使用Pro-kin平衡系统的本体感觉评估模块定量检测平均轨迹误差（ATE）和平均负重不对称性（AWA）。采用肌肉骨骼超声检测痉挛侧和健侧腓肠肌，获取纵、横超声图像，测量肌纤维长度、内侧头羽状角和肌肉厚度。采用Spearman相关性分析探讨MAS评分与各参数之间的相关性，构建多元线性回归模型分析痉挛的影响因素，并通过受试者工作特征（ROC）曲线评估超声参数的预测性能。
与健侧相比，痉挛侧腓肠肌的肌纤维长度、内侧头羽状角和肌肉厚度均显著降低（P<0.05）。本体感觉参数的平均轨迹差异为（65.83±13.11）%，平均负重力量差异为（2.41±0.46）kg。相关性分析显示，MAS痉挛评分与本体感觉参数和肌肉结构参数具有统计学显著相关性（P<0.05），多元线性回归分析显示，肌肉羽状角（β=0.362）、肌纤维长度（β=-0.157）、肌肉厚度（β=-0.230）、平均轨迹误差（β=0.329）和平均负重力量差异（β=0.260）构成MAS评分的独立影响因素（调整R²=0.787，P<0.05）。ROC曲线分析显示，肌肉羽状角预测痉挛（MAS≥2级）的曲线下面积最大（AUC=0.850，95%CI：0.729-0.972），优于肌纤维长度（AUC=0.840）和肌肉厚度（AUC=0.838）。
脑卒中患者下肢痉挛与本体感觉和肌肉结构参数之间存在显著相关性，本体感觉和肌肉结构参数是影响痉挛的关键因素，肌肉骨骼超声可作为脑卒中患者下肢痉挛的定量评估工具。
