Objective:This study aims to explore the application value of quantitatively evaluating and comparing the elastic modulus of shoulder girdle muscles between healthy adults and patients with scapular dyskinesis by using shear wave elastography (SWE).Methods:A case-control study was conducted. From Mar 2019 to Sep 2019, 33 patients (33 shoulders) with scapular dyskinesis(SD) including 10 males and 23 females aged 35 to 71 years from China Rehabilitation Research Center were selected into SD group. In the same period, 32 healthy volunteers (61 shoulders) including 10 males and 22 females aged from 22 to 74 years were also recruited as control group. Thickness, shear wave velocity of upper trapezius (UT), levator scapulae (LS), middle trapezius (MT), rhomboid (RM), lower trapezius (LT), and serratus anterior (SA) were measured with 2-D ultrasound and SWE. Elastic modulus was calculated. Thickness and elastic modulus of shoulder girdle muscles were compared between SD and control groups, and the effects of age and sex on thickness and elastic modulus of shoulder girdle muscles were analyzed.Results:Patients with SD had higher elastic modulus of UT, UT/MT, UT/LT(44.42±29.17) kPa (1 mmHg=0.133 kPa), 1.59±0.56, and 1.56±0.63 than healthy adults (31.00±12.68) kPa, 1.30±0.30, and 1.30±0.30, but had lower thickness of LS (0.40±0.11) cm than healthy adults (0.47±0.17) cm, and the differences were statistically significant (all P values < 0.05). The elastic modulus of RM in young patients with SD (31.14±3.93 )kPa was higher than that of young healthy adults (23.30±8.24) kPa. The UT/SA in middle-aged patients with SD (1.57±0.38) was greater than that of middle-aged healthy adults (1.30±0.33). Moreover, the UT/MT, the elastic modulus of UT, LS, and SA in elderly patients with SD [1.81±0.68, (53.59±36.99) kPa, (36.54±11.41) kPa, (18.51±8.05) kPa] were greater than those of elderly healthy adults [1.40±0.39, (32.01±11.93) kPa, (28.82±9.42) kPa, (13.04±7.23) kPa]. The differences were statistically significant (all P values<0.05). Among the 32 healthy adults and 33 patients with SD, SA was significantly thicker in males [(0.82±0.24) cm and (0.80±0.17) cm] than in females[ (0.63±0.15) cm and (0.69±0.17 )cm]. Furthermore, the elastic modulus of UT was greater in females[(32.91±13.87) kPa than in males (26.77±8.37) kPa], and the difference was statistically significant (all P values<0.05). Among the 32 healthy adults, SA thickness, elastic modulus of LT, and SA were negatively associated with age ( r=-0.334, -0.416, -0.431). UT/LT and UT/SA were positively associated with age ( r=0.317, 0.300). Among the 33 patients with SD, UT/MT and elastic modulus of LS were positively associated with age ( r=0.410, 0.399). However, the elastic modulus of RM was negatively associated with age ( r=-0.317, -0.300), and the difference was statistically significant (all P values<0.05). Conclusions:SWE can be used to quantify the elastic modulus of shoulder girdle muscles and can reflect the characteristics of imbalance of scapular muscle couple in patients with SD. This work provides certain guiding significance for prevention, early diagnosis, and precision rehabilitation of SD.

目的 探讨应用超声弹性成像技术定量评价脑卒中后前臂屈肌痉挛的可行性及其特点.方法 2019年1月至10月,脑卒中后屈腕和屈指肌痉挛的住院患者30例,采用超声弹性成像测量前臂屈肌群桡侧腕屈肌(FCR)、尺侧腕屈肌(FCU)、指浅屈肌(FDS)和指深屈肌(FDP)剪切波速度(SWV),采用改良Ashworth量表(MAS)评定屈腕和屈指肌张力.结果 患侧和健侧各肌肉SWV在牵伸位时均显著高于放松位(|Z|>3.844,P<0.001);牵伸位时,患侧各肌肉SWV显著高于健侧(|Z|>3.593,P<0.001);牵伸位与放松位SWV差值比较,患侧各肌肉明显高于健侧(t>3.199,P<0.01);各肌肉牵伸位平均SWV与屈腕MAS评分显著相关(r=0.605,P<0.001);指浅屈肌和与指深屈肌牵伸位平均SWV与屈指MAS评分明显相关(r=0.540,P<0.01).结论 超声弹性成像可以定量评价脑卒中后前臂屈肌群内不同肌肉的痉挛程度.

目的 利用超声剪切波弹性成像对脑卒中后伴发单侧下肢运动障碍患者跟腱及小腿三头肌(腓肠肌内、外侧头及比目鱼肌)进行评价,分析临床价值.方法 选取51例脑卒中后伴发单侧下肢运动障碍患者,患侧为病例组,健侧为对照组,对双侧跟腱及小腿三头肌进行灰阶超声和剪切波弹性成像检查.分别记录跟腱长度(比目鱼肌肌腱长度为准)、厚度及跟腱与小腿三头肌剪切波速度(SWV).将患者双侧小腿三头肌牵拉至最大背屈位,后再次进行剪切波弹性成像检测.并进行统计学分析.结果 51例患者双侧跟腱比较,患侧跟腱长度较健侧长,跟腱内径无明显差别;剪切波弹性成像比较,患侧跟腱及小腿三头肌剪切波速度明显较健侧增高,硬度明显增加;牵拉后,双侧小腿三头肌剪切波传播速度明显增快(P＜0.01).结论 超声剪切波弹性成像可以量化跟腱及小腿三头肌(腓肠肌内、外侧头及比目鱼肌)的弹性特征,可用于指导脑卒中患者的康复治疗.

目的 观察猪标本超声引导下腰椎经椎间孔硬膜外注射的可行性及准确性.方法 取来自2只巴马小型猪的L1-6节段脊柱及椎旁部分组织,分别在双侧L1-2、L2-3、L3-4、L4-5、L5-6椎间孔完成超声引导下经椎间孔硬膜外穿刺,应用腰椎X线片和CT检测穿刺针位置;大体观察穿刺针入路和针尖位置,记录穿刺针皮肤入针点与后正中线距离、入针深度和入针角度,并进行左右对比.结果 穿刺成功率95％(19/20),其中穿刺针针尖位于椎间孔下缘、腹侧、中央区和旁中央区的占80％(16/20).成功穿刺时,左右侧穿刺针皮肤入针点与后正中线距离、入针深度、入针角度无显著性差异(|t|<1.475,P>0.05).结论 超声引导下经椎间孔硬膜外穿刺有较高准确率.

目的 探讨超声剪切波弹性成像对脑卒中下肢运动障碍患者小腿三头肌和跟腱进行康复评定的价值.方法 2018年至2019年,脑卒中后单侧下肢运动障碍住院患者32例,于康复治疗前后,对患者双侧小腿三头肌和跟腱行超声二维测量和剪切波弹性成像检查,记录剪切波速度(SWV)以及跟腱(比目鱼肌肌腱)长度和厚度.结果 治疗前,患侧跟腱和小腿三头肌SWV较健侧增高(t>2.426,P<0.05);患侧跟腱长度较健侧显著增加(t=11.801,P<0.001);治疗后,患侧小腿三头肌SWV减低(t>2.447,P<0.05);患侧跟腱长度显著缩短(t=8.577,P<0.001).结论 康复治疗可降低脑卒中下肢运动障碍患者小腿三头肌肌张力.超声剪切波弹性成像可用于评价跟腱和小腿三头肌弹性特征,指导脑卒中康复.

腰背部疼痛常常由腰椎间盘突出症、腰椎管狭窄症、小关节病变等引起,是目前的常见病和多发病.临床上常使用腰椎注射技术来治疗腰背部疼痛,以往多在无影像设备引导的情况下进行,随着临床对安全性和科学性要求的提高,腰椎注射逐渐开始在影像学的引导下进行.目前在临床上腰椎注射常在X线或CT引导下进行,但由于超声有诸多的优点,比如操作便捷、可以大大减少患者和医护人员接受的辐射量、穿刺整个过程实时可见等,因此逐渐在临床上普及.

Objective To discuss the detection rate of adult normal laryngeal anatomic structure of different ages using high frequency ultrasound,in order to provide clinical application feasibility data supporting for further research.Methods A total of 307 healthy adults (male 144 and female 163) were included.The thyroid cartilage,cricothyroid membrane,epiglottic cartilage,preepiglottic space,paraglottic space,ventricular fold,vocal cord,arytenoids muscle,arytenoid cartilage and piriform recess were all showed clearly using high frequency ultrasound.Results The display rates of thyroid cartilage epiglottis cartilage,cricoid cartilage and cricothyroid membrane among different gender and age groups were high with no statistical differences.The display rates of arytenoid,paraglottic space,ventricular fold,vocal cord,arytenoids muscle and piriform recess showed statistically difference among different sexes and different age groups (P ＜ 0.05).The display rates of paraglottic space,ventricular fold,vocal cord,arytenoids muscle in women were higher than those in men in similar cohorts.Conclusions The high-frequency ultrasound is a comprehensive,safe,convenient and non-invasive imaging examination method.It can provide the required information for clinic.

Objective To study the value of color Doppler ultrasound in diagnosis of deep vein thrombosis (DVT) of lower extremity and pulmonary embolism (PE) in spinal cord injury (SCI). Methods 60 PE patients (PE group) and 35 SCI patients without PE (control group) received color Doppler ultrasound examination for DVT of lower extremity. Results PE group included 36 SCI patients (PE-SCI group) and 24 no-SCI patients (PE-no-SCI group). There were 15 cases with lower extremity thrombosis in PE-SCI group, and 9 cases in PE-no-SCI group (P>0.05), while there were 5 cases in the control group. There was significantly different in lower extremity thrombosis be-tween PE group and the control group (P<0.01). In PE group, the detection rate was not significantly different between acute PE (detected 11 cases out of 37 cases) and chronic PE (detected 10 cases out of 23 cases) (P>0.05). 31 cases were rechecked as lower extremity venous valve regurgitation and calf muscle vein dilation (51.7%) in PE group while 8 cases in the control group (22.9%) (P<0.01). Conclusion There is not significantly different in the detection rate of DVT of lower extremity in PE patients with and without spinal cord injury, which are higher than in the patients without PE. Color Doppler ultrasound is necessary to check DVT in acute and chronic PE patients.

Objective To explore the clinical value of echocardiography for the diagnosis of idiopathic pulmonary arterial hypertension.Methods 59 patients with idiopathic pulmonary arterial hypertension were received in Mudan People′s Hospital of Heze City in Shandong Province from December 2010 to November 2012 as observation group.Echocardiography and cardiac catheter detection were used.60 health physical examination cases were as the control group at the same time.Echocardiography was applied only in the later.The results of echocardiography between two groups and the results of echocardiography and cardiac catheter of observation group were compared and analyzed,in order to find the correlations between the two detection methods.SPSS 16.0 software was used for statistical analysis.Results The pulmonary artery pressure(PAP)(89.4±26.5)mm Hg(1 mm Hg = 0.133 kPa) of observation group was remarkably higher than that(29.3±10.4)mm Hg of control group.The pulmonary artery diameter(28.1±4.3) mm was significantly less than that(32.7±4.2)mm of control group.The RATD and RALD were obviously more than that of control group.It had the statistical difference(all P 0.05).The patients of observation group showed inordinate dilated left atrium and pulmonary artery thickening with tricuspid regurgitation occurring simultaneously.The PAP(84.6±25.7)mm Hg of using cardiac catheter in observation was lower than it(89.4±26.5)mm Hg with echocardiography.It had no significance(P 0.05).Echocardiography had the correlation with cardiac catheter detection(r = 0.719,P = 0.003).56 cases were diagnozed to be idiopathic pulmonary arterial hypertension with echocardiography,only 3 ones were misdiagnosed among them.The clinical diagnose accordance rate was 94.9%.The misdiagnosed was confirmed after cardiac catheter detection.The PAP(90.8±24.6)mm Hg of patients with depression of left ventricle contraction in observation group was remarkably higher than(65.7±19.0)mm Hg of normal left ventricle contraction(P 0.05).Conclusion Echocardiography is a safe,noninvasive method.It has higher accuracy and repeatability and has important clinical value in diagnosis of idiopathic pulmonary arterial hypertension.It is worthy of promotion in clinic.

目的 分析北京社区人群的颈动脉粥样硬化及颈动脉斑块分布情况,并探讨颈动脉超声检查的标准化方法.方法 随机抽取北京地区首钢和石景山2个社区自然人群共1 269例,超声检测颈动脉内膜内表面到中膜外表面的距离(IMT),同时注意观察颈动脉斑块的位置、数量及性质等.结果 总体人群中男性颈动脉斑块阳性率明显高于女性(分别为47.4％和28.2％,P＜0.001),36～45岁组颈动脉斑块发生率没有性别间差异,46～55岁组男性颈动脉斑块发生率及颈动脉斑块总积分均较女性为高(P＜0.001),而≥56岁组颈动脉斑块发生率及颈动脉斑块总积分没有性别间差异.同性别颈动脉斑块阳性率和颈动脉斑块总积分均随年龄增加而显著增高(P＜0.001).颈动脉不光滑和粥样硬化形成者中,颈总动脉近端、远端及颈内动脉起始部IMT值分别与颈总动脉分叉处IMT值有显著性差异.扁平斑块者的IMT值均显著低于同时具有其他性质的斑块者,颈动脉斑块总积分与双侧颈总动脉分叉处后壁IMT值显著相关.结论 北京社区人群中颈动脉粥样硬化状况存在性别和年龄间的显著差异,颈动脉超声检查能够准确评价人群中的颈动脉斑块分布特征及规律,可以推断人群中的全身动脉粥样硬化情况,从而预测冠心病的发生.

Objective:To investigate the differences on asses the left ventricular diastolic function by tissue Doppler image and omnidirectional M mode Echocardiography.Method:This study included 29 patients who underwent left-sided cardiac catheterization with left ventricular diastolic dysfunction divided into three groups: relaxation delaying (group A, 11 cases); pseudonormal filling(group B, 12 cases); restrictively filling (group C, 6 cases),and 15 normal control subjects were studied with tissue Doppler image and omnidirectional M mode echocardiography. Tissue Doppler image data including Ea and Aa were acquire from mitral annular on apical four-chamber left ventricular two-chamber and apical three-chamber and the Ea/Aa ratio was calculated. The maximum systolic velocities (VS) and early-diastolic velocities (VD) of 6 regional left ventricular segments at short-axis sections of papillary muscle level were measured by omnidirectional M mode echocardiography, and the VD/VS ratio was calculated.Result:the specificity was 96.7% and 94.4% by two moths,respectively. the sensitivity was 71.2%, 90.3% and 97.7% by tissue Doppler image in each group,respectively. Taking VD/VS≤1.0 to diagnose diastolic function, the sensitivity was 56.1%, 65.3% and 96.5% by omnidirectional M mode echocardiography in each group, respectively.Conclusion:The two methods can be regarded as valuable methods for estimating left ventricular diastolic function. DTI is sensitive in comparison with omnidirectional M mode Echocardiography.