肩胛骨动力障碍中剪切波成像与表面肌电图的相关性分析
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摘要
目的通过分析剪切波成像与表面肌电图评估肩胛骨动力障碍(SD)中肌肉硬度的相关性,探讨剪切波在SD中的应用价值。方法选择2017年4月至2018年4月广东省人民医院康复科就诊KiblerⅢ型SD患者22例(SD组),其中男性15例,女性7例;年龄20～33岁,平均年龄25.00岁。同期健康志愿者22例(对照组),其中男性13例,女性9例;年龄18～28岁,平均年龄21.00岁。分别采用剪切波成像和表面肌电图评价上斜方肌、肩胛提肌和菱形肌的肌肉硬度,分析两种方法检测结果的相关性。结果 SD组中上斜方肌、肩胛提肌和菱形肌的剪切波杨氏模量值均比对照组增高(64.53 kPa±6.44 kPa vs 36.18 kPa±6.54 kPa,46.16 kPa±7.72 kPa vs 41.69 kPa±6.91 kPa,31.85 kPa±6.13 kPa s27.59kPa±4.36 kPa),差异具有统计学意义(P<0.05);SD组上斜方肌、肩胛提肌和菱形肌表面肌电图均方根(RMS)值均比对照组增高(23.81μV±3.41μV vs 18.13μV±2.63μV,20.95μV±3.07μV vs 18.04μV±2.33μV,24.22μV±3.19μVvs 21.59μV±2.36μV),差异具有统计学意义(P<0.05)。SD组上斜方肌、肩胛提肌的剪切波杨氏模量值与表面肌电图RMS值呈正相关(r=0.61、0.49,P<0.01、0.05),菱形肌的剪切波模量值与表面肌电图RMS值无明显相关(P>0.05)。结论剪切波能够准确量化评估SD中肌肉的硬度。
Objective To analysis the correlation between shear wave and the surface electromyogram in evaluation of muscle stiffness in scapular dyskinesia(SD), and explore the application value of shear wave in SD. Methods From April 2017 to April 2018, 22 patients with Kibler Ⅲ SD(SD group) were enrolled, which included 15 males and 7 females, aged 20-33 years old with mean age of 25.00 years old. Twenty-two healthy volunteers were enrolled as control group, which included 13 males and 9 females; aged 18-28 years old with mean age of 21.00 years old. The muscle stiffness of upper trapezius, scapula levator and rhomboid muscle were evaluated by shear wave imaging and surface electromyography, and correlation of test results was analyzed between 2 methods. Results The shear wave Young's modulus values of upper trapezius muscle, scapula levator muscle and rhomboid muscle in SD group were higher than those in control group(64.53 kPa ± 6.44 kPa vs 36.18 kPa ±6.54 kPa, 46.16 kPa ± 7.72 kPa vs 41.69 kPa ± 6.91 kPa, 31.85 kPa ± 6.13 kPa vs 27.59 kPa ± 4.36 kPa), and the differences were statistically significant(P < 0.05); The root mean square(RMS) value of surface electromyogram of trapezius, scapula and rhomboid muscle in SD group were higher than those in control group(23.81 μV ± 3.41 μV vs 18.13 μV ± 2.63 μV,20.95 μV ± 3.07 μV 18.04 μV ± 2.33 μV, 24.22 μV ± 3.19 μV vs 21.59 μV ± 2.36 μV), and the diifferences were statistically significant(P < 0.05). In SD group, the shear wave Young's modulus values of trapezius muscle and levator scapulae were positively correlated with RMS value of surface electromyogram(r = 0.61, 0.49, P < 0.01, 0.05), and there was no significant correlation between shear wave modulus of rhomboid muscle and RMS value of surface electromyogram(P > 0.05). Conclusion It is demonstrated that shear waves could accurately quantify the stiffness of muscles in SD.
Objective To analysis the correlation between shear wave and the surface electromyogram in evaluation of muscle stiffness in scapular dyskinesia(SD), and explore the application value of shear wave in SD. Methods From April 2017 to April 2018, 22 patients with Kibler Ⅲ SD(SD group) were enrolled, which included 15 males and 7 females, aged 20-33 years old with mean age of 25.00 years old. Twenty-two healthy volunteers were enrolled as control group, which included 13 males and 9 females; aged 18-28 years old with mean age of 21.00 years old. The muscle stiffness of upper trapezius, scapula levator and rhomboid muscle were evaluated by shear wave imaging and surface electromyography, and correlation of test results was analyzed between 2 methods. Results The shear wave Young's modulus values of upper trapezius muscle, scapula levator muscle and rhomboid muscle in SD group were higher than those in control group(64.53 kPa ± 6.44 kPa vs 36.18 kPa ±6.54 kPa, 46.16 kPa ± 7.72 kPa vs 41.69 kPa ± 6.91 kPa, 31.85 kPa ± 6.13 kPa vs 27.59 kPa ± 4.36 kPa), and the differences were statistically significant(P < 0.05); The root mean square(RMS) value of surface electromyogram of trapezius, scapula and rhomboid muscle in SD group were higher than those in control group(23.81 μV ± 3.41 μV vs 18.13 μV ± 2.63 μV,20.95 μV ± 3.07 μV 18.04 μV ± 2.33 μV, 24.22 μV ± 3.19 μV vs 21.59 μV ± 2.36 μV), and the diifferences were statistically significant(P < 0.05). In SD group, the shear wave Young's modulus values of trapezius muscle and levator scapulae were positively correlated with RMS value of surface electromyogram(r = 0.61, 0.49, P < 0.01, 0.05), and there was no significant correlation between shear wave modulus of rhomboid muscle and RMS value of surface electromyogram(P > 0.05). Conclusion It is demonstrated that shear waves could accurately quantify the stiffness of muscles in SD.
引文
[1] Kibler WB, Uhl TL, Maddux JW, et al. Qualitative clinical evaluation of scapular dysfunction:a reliability study[J]. J Shoulder Elbow Surg, 2002,11(6):550-556.
[2] Kelly GP, Koppenhaver SL, Michener LA, et al. Charaterization of tissue stiffness of the infra-spinatus, erector spinae,and gastrocnemius muscle using ultrasound shear wave elastrgraphy and superficial mechanical deformation[J]. J Electromyogr Kinesiol, 2018, 38:73-80.
[3]Matsubara T,Arai YC,Shiro Y,et al. Comparative effects of acupressure at local and distal acupuncture points on pain conditions and autonomic function in females with chronic neck pain[J]. Evid Based Complement Alternat Med, 2011,2011:543291-543291.
[4]Debemard LT,Robert LD,Charleux F, et al.Analysis of thigh muscle stiffness from child-hood to adulthood using magnetic resonance elastography technique[J]. Clin Biomech(Bristol,Avon), 2011, 26(8):836-840.
[5] Liu CL, Feng YN, Zhang HQ, et al. Assessing the viscoelastic properties of upper trapezius muscle:Intra-and intertester reliability and the effect of shoulder elevation[J].J Electromyogr Kinesiol, 2018, 43:226-229.
[6] Baumer TG, Davis L, Dishcher J, et al. Shear wave elastography of the supraspinatus muscle and tendon:Repeatability and preliminary findings[J]. J Biomech, 2017, 53:201-204.
[7] DENG Si-min, CHEN Kang, HE Lan-juan, et al. Investigation on the occurrence of scapular dyskinesis in shoulderneck pain[J]. Chinese Journal of Rehabilitation Medicine, 2016,31(7):756-760.[邓思敏,陈康,何岚娟,等.肩胛骨动力障碍在肩颈痛中发生情况调查[J].中国康复医学杂志,2016,31(7):756-760.]
[8] Castelein B, Cools A, Parlevliet T, et al. Are chronic neck pain, scapular dyskinesis and altered scapulothoracic muscle activity interrelated? A case-control study with surface and fine-wire EMG[J].J Electromyogr Kinesiol, 2016,31:136-143.
[9] de Araújo RC,Pirau6 ALT,Beltrao NB,et al.Activity of periscapular muscles and its correlation with external oblique during push-up:Does scapular dyskinesis change the electromyographic response[J]? J Sports Sci, 2018, 36(5):571-577.
[10] Huang TS, Ou HL, Huang CY, et al. Specific kinematics and associated muscle activation in individuals with scapular dyskinesis[J]. J Shoulder Elbow Surg, 2015, 24(8):1227-1234.
[11] Kuo WH, Jian DW, Wang TG, et al. Neck muscle stiffness quantified by sonoelastography is correlated with body mass index[J]. Ultrasound Med Biol, 2013, 39(8):1356-1361.
[12] McClure P, Greenberg E, Karaha S. Evaluation and management of scapular dysfunction[J]. Sports Med Arthrosc Rev,2012, 20(1):39-48.
[13] Deng S, Chen K, Ma Y, et aL The influence of test positions on clinical assessment for scapular dyskinesis[J]. PM R, 2017, 9(8):761-766.
[14] Leow MQH, Cui SL, Cao T, et al. Measuring the effects of acupuncture on muscle stiffness with shear wave elastography[J]. Aupunct Med, 2017, 35(4):304-306.
[15] Demirel A, Baykara M, Koca TT, et al. Ultrasound elastograhy-based assessment of the elasticity of the supraspinatus muscle in impingement syndrome:dose elastography has any diagnostic value[J]? Clin Rheumatol, 2018, 37(6):1661-1665.
[16] Guo L, Zhang C,Zhang DD, et al. Application of shear wave elastography in the evaluation of neck-shoulder myofascial pain syndrome[J]. Zhongguo Gu Shang, 2016, 29(2):142-145.[郭玲,张展,张丁丁,等.剪切波超声弹性成像技术在颈肩筋膜疼痛综合征的应用[J].中国骨伤,2016,29(2):142-145.]
[2] Kelly GP, Koppenhaver SL, Michener LA, et al. Charaterization of tissue stiffness of the infra-spinatus, erector spinae,and gastrocnemius muscle using ultrasound shear wave elastrgraphy and superficial mechanical deformation[J]. J Electromyogr Kinesiol, 2018, 38:73-80.
[3]Matsubara T,Arai YC,Shiro Y,et al. Comparative effects of acupressure at local and distal acupuncture points on pain conditions and autonomic function in females with chronic neck pain[J]. Evid Based Complement Alternat Med, 2011,2011:543291-543291.
[4]Debemard LT,Robert LD,Charleux F, et al.Analysis of thigh muscle stiffness from child-hood to adulthood using magnetic resonance elastography technique[J]. Clin Biomech(Bristol,Avon), 2011, 26(8):836-840.
[5] Liu CL, Feng YN, Zhang HQ, et al. Assessing the viscoelastic properties of upper trapezius muscle:Intra-and intertester reliability and the effect of shoulder elevation[J].J Electromyogr Kinesiol, 2018, 43:226-229.
[6] Baumer TG, Davis L, Dishcher J, et al. Shear wave elastography of the supraspinatus muscle and tendon:Repeatability and preliminary findings[J]. J Biomech, 2017, 53:201-204.
[7] DENG Si-min, CHEN Kang, HE Lan-juan, et al. Investigation on the occurrence of scapular dyskinesis in shoulderneck pain[J]. Chinese Journal of Rehabilitation Medicine, 2016,31(7):756-760.[邓思敏,陈康,何岚娟,等.肩胛骨动力障碍在肩颈痛中发生情况调查[J].中国康复医学杂志,2016,31(7):756-760.]
[8] Castelein B, Cools A, Parlevliet T, et al. Are chronic neck pain, scapular dyskinesis and altered scapulothoracic muscle activity interrelated? A case-control study with surface and fine-wire EMG[J].J Electromyogr Kinesiol, 2016,31:136-143.
[9] de Araújo RC,Pirau6 ALT,Beltrao NB,et al.Activity of periscapular muscles and its correlation with external oblique during push-up:Does scapular dyskinesis change the electromyographic response[J]? J Sports Sci, 2018, 36(5):571-577.
[10] Huang TS, Ou HL, Huang CY, et al. Specific kinematics and associated muscle activation in individuals with scapular dyskinesis[J]. J Shoulder Elbow Surg, 2015, 24(8):1227-1234.
[11] Kuo WH, Jian DW, Wang TG, et al. Neck muscle stiffness quantified by sonoelastography is correlated with body mass index[J]. Ultrasound Med Biol, 2013, 39(8):1356-1361.
[12] McClure P, Greenberg E, Karaha S. Evaluation and management of scapular dysfunction[J]. Sports Med Arthrosc Rev,2012, 20(1):39-48.
[13] Deng S, Chen K, Ma Y, et aL The influence of test positions on clinical assessment for scapular dyskinesis[J]. PM R, 2017, 9(8):761-766.
[14] Leow MQH, Cui SL, Cao T, et al. Measuring the effects of acupuncture on muscle stiffness with shear wave elastography[J]. Aupunct Med, 2017, 35(4):304-306.
[15] Demirel A, Baykara M, Koca TT, et al. Ultrasound elastograhy-based assessment of the elasticity of the supraspinatus muscle in impingement syndrome:dose elastography has any diagnostic value[J]? Clin Rheumatol, 2018, 37(6):1661-1665.
[16] Guo L, Zhang C,Zhang DD, et al. Application of shear wave elastography in the evaluation of neck-shoulder myofascial pain syndrome[J]. Zhongguo Gu Shang, 2016, 29(2):142-145.[郭玲,张展,张丁丁,等.剪切波超声弹性成像技术在颈肩筋膜疼痛综合征的应用[J].中国骨伤,2016,29(2):142-145.]