阮坚 潘永寿 皮永前 路海燕 舒真祥

【摘要】 目的 探討剪切波弹性成像（SWE）量化评估脑卒中后下肢痉挛偏瘫患者跟腱（AT）硬度的可行性。

方法 选择2019年3月～2020年10月接受康复治疗的30例脑卒中后下肢痉挛偏瘫患者，患侧为病例组，健侧为对照组。利用灰阶超声及SWE技术分别测量并记录治疗前健患两侧及治疗3周后患侧AT的厚度及最大杨氏模量值，对结果进行统计学分析。

结果 30例患者治疗前患侧AT的最大杨氏模量值高于健侧，治疗3周后患侧AT的最大杨氏模量值较治疗前降低，差异有统计学意义（均P<0.001）。而治疗前健患侧以及治疗3周后患侧AT的厚度之间比较，差异无统计学意义（均P>0.05）。Pearson 相关性分析显示30例患者治疗前、治疗3周后患侧AT最大杨氏模量值与其AT厚度均无明显相关性（r=0.240、r=0.167，均P>0.05）。

结论 SWE技术能够定量评估脑卒中患者跟腱弹性硬度的变化，为临床提供跟腱量化指标，指导康复治疗。

【关键词】 脑卒中;跟腱;剪切波弹性成像技术;杨氏模量值;硬度

中图分类号：R493   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.09.009

Study on evaluation of Achilles tendon hardness in patients with spasticity and  hemiplegia of lower limbs after stroke by shear wave elastography

RUAN Jiana， PAN Yongshoua， PI Yongqiana， LU Haiyana， SHU Zhenxiangb

（a. Ultrasound Department， b.Rehabilitation Department， Liutie Central Hospital of Liuzhou City， Liuzhou 545007， Guangxi， China）

【Abstract】 Objective To explore the feasibility of shear wave elastography （SWE） in quantitative evaluation of the hardness of the Achilles tendon （AT） in patients with hemiplegia of lower limbs after stroke.

Methods 30 patients with spastic hemiplegia of lower limbs after stroke who received rehabilitation treatment from March 2019 to October 2020 were selected. The affected sides were selected as  case group， and the healthy sides as control group. The hardness and maximum Young's modulus values on both affected sides and healthy sides of patients before treatment as well as on the affected sides after 3 weeks of treatment were measured and recorded by gray-scale ultrasound and SWE technology， and the results were statistically analyzed.

Results Before treatment， the maximum Young's modulus values of the affected sides of 30 patients were higher than those of the healthy sides， and the maximum Young's modulus values of the affected sides after 3 weeks of treatment were lower than those before treatment， difference was statistically significant （all P < 0.001）. There was no statistically significant difference in the hardness of AT between the healthy sides before treatment and the affected sides after 3 weeks of treatment （all P > 0.05）. Pearson correlation analysis showed that there was no significant correlation between the maximum Young's modulus values of the AT and the hardness of AT on affected sides before treatment and 3 weeks after treatment among the 30 patients （r = 0.240， r = 0.167， all P > 0.05）.

Conclusion SWE technology can quantitatively assess the changes in the elasticity of the Achilles tendon in stroke patients， provide clinical quantitative indicators for the Achilles tendon， and guide rehabilitation.

【Key words】 stroke; AT; SWE technology; Young's modulus value; hardness

跟腱是人体最粗的肌腱，由小腿浅层肌群小腿三头肌（腓肠肌内、外侧头和比目鱼肌）肌腱汇合而成，连接小腿三头肌与跟骨，传导肌肉至骨骼的力量，其主要作用是跖屈足踝关节，维持足踝关节活动稳定。跟腱是一种黏弹性结构，具有独特的生物力学特性。而跟腱弹性硬度是生物力学特性表现。跟腱形变或损伤可引起其硬度的改变，如何定量评估跟腱生物力学特性（硬度），对脑卒中后下肢痉挛偏瘫患者康复治疗有重要意义。剪切波弹性成像（shear wave elastography，SWE）作为一种安全、无创、能够定量评估组织硬度的新技术，广泛运用于肝脏[1]、甲状腺[2～3]、乳腺[4～5]、肌肉[6]、神经[7]等疾病诊断。但将……