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目的观察基于超声弹性成像技术评价康复治疗前后肢体硬度变化对痉挛性偏瘫患者预后的影响。方法应用超声弹性成像检测20例健康人(正常对照组)和2013年7月—2015年12月在浙江省台州医院住院的脑卒中后偏瘫下肢痉挛状态的20例患者(观察组)康复治疗前后下肢股外侧肌、股内侧肌、股直肌及股二头肌的弹性变化,观察康复治疗前和治疗4周后痉挛下肢肌肉弹性变化对预后的影响。结果治疗前观察组健侧与患侧纵切应变比较差异有统计学意义(P<0.01),与正常对照组比较,观察组患侧股外侧肌、股内侧肌、股直肌及股二头肌纵切应变均升高(P<0.01);治疗4周后观察组痉挛侧膝关节屈曲状态下股外侧肌、股内侧肌、股直肌及股二头肌纵切应变比治疗前下降(P<0.05),与正常对照组比较,观察组患侧股外侧肌、股内侧肌、股直肌纵切应变下降(P<0.05),但股二头肌纵切应变无明显变化(P>0.05),当膝关节伸展状态下膝关节观察组患侧股外侧肌、股内侧肌、股直肌应变率比检测及正常对照组下降(P<0.05),但患侧股二头肌与正常对照组比较差异无统计学意义(P>0.05)。结论超声弹性成像技术可以定量评价脑卒中后痉挛下肢肌张力变化,可作为其康复预后评价方法。
Objective To evaluate the effect of limb stiffness changes on the prognosis of patients with spastic hemiplegia based on ultrasound elastography before and after rehabilitation. Methods Twenty healthy subjects (control group) and 20 patients with post-stroke hemiplegia spasticity (observation group) who were hospitalized in Taizhou Hospital of Zhejiang Province from July 2013 to December 2015 were detected by ultrasound elastography before and after rehabilitation The changes of the elasticity of the lower extremity lateralis medialis, the medialis lateralis, the rectus femoris and the biceps femoris were observed. The changes of the muscle elasticity of lower extremity before and after rehabilitation were observed. Results Before treatment, there was significant difference in the longitudinal strain between the contralateral side and the affected side (P <0.01). Compared with the normal control group, the lateral femoris, the medial femur, the rectus femoris and the femoral head (P <0.01). After 4 weeks of treatment, the longitudinal strain in the lateral femoral, medial, rectus femoris and biceps femoris in the spastic knee flexion group was lower than that before treatment (P <0.05). Compared with the normal control group, the longitudinal strain in the lateral femoris, the medialis and the rectus muscle of the observation group decreased (P <0.05), but there was no significant change in the longitudinal strain of the biceps femoris muscle (P> 0.05). Compared with the normal control group, the strain rate of the lateral femoris, the medialis and the rectus muscles of the knees in the knee extension group were lower than those in the normal control group (P <0.05), but the biceps femoris and normal There was no significant difference in the control group (P> 0.05). Conclusion Ultrasound elastography can quantitatively evaluate the changes of muscle tension in lower extremities after stroke and can be used as a method to evaluate the prognosis of rehabilitation.