背景:在临床工作中,医疗人员主要以触诊的方法评估颈肩痛患者颈部软组织的僵硬程度,主观性强,缺乏客观依据.实时剪切波弹性成像是一种定量弹性超声技术,能够客观评估肌肉组织弹性值,评价肌肉状态. 目的:应用实时剪切波弹性成像评估颈肩痛患者斜角肌的僵硬程度,观察颈肩痛患者双侧前斜角肌与中后斜角肌的肌肉硬度变化特征. 方法:于2021年12月至2022年6月在广州中医药大学深圳医院(福田)招募健康者受试者(对照组)36例和颈肩痛患者(试验组)36例,在颈部中立位及侧屈位时,应用实时剪切波弹性成像测量两组双侧前、中后斜角肌弹性模量平均值及横截面积. 结果与结论:①在相同体位下,两组组内左侧与右侧前斜角肌的弹性模量平均值、左侧与右侧中后斜角肌的弹性模量平均值比较差异均无显著性意义(P>0.05),两组组内左侧与右侧前斜角肌的横截面积、左侧与右侧中后斜角肌的横截面积比较差异均无显著性意义(P>0.05),两组组内中后斜角肌的弹性模量平均值与横截面积均高于前斜角肌(P<0.01,P<0.001);②在颈部中立位及侧屈位时,试验组前斜角肌、中后斜角肌的弹性模量平均值高于对照组(P<0.001),前斜角肌、中后斜角肌的横截面积均低于对照组(P<0.01,P<0.001);③结果表明,应用实时剪切波弹性成像技术能直观地评价颈肩痛患者前、中后斜角肌在颈部肌肉不同状态下弹性模量的差异,颈肩痛患者的双侧斜角肌处于劳损、僵硬状态.
BACKGROUND:In clinical work,the stiffness of neck soft tissue in patients with neck and shoulder pain is mainly detected through palpation,which is highly subjective and lacks an objective basis.Real-time shear wave elastography is a quantitative elastic ultrasound technique that can objectively assess muscle elasticity and muscle status. OBJECTIVE:To apply real-time shear wave elastography to assess the stiffness of scalene muscles in patients with neck and shoulder pain and to observe the characteristics of muscle stiffness changes in the bilateral anterior,middle and posterior scalene muscles in patients with neck and shoulder pain. METHODS:From December 2021 to June 2022,36 healthy subjects(control group)and 36 patients with neck and shoulder pain(test group)were recruited at the Shenzhen Hospital of Guangzhou University of Chinese Medicine.Real-time shear wave elastography was applied to measure the mean values of elastic modulus and cross-sectional area of the anterior and middle and posterior scalene muscles bilaterally in the neutral and lateral flexion positions of the neck in both groups. RESULTS AND CONCLUSION:In the same position,there were no significant differences between the mean Values of elastic modulus of the left and right anterior scalene muscles as well as between the mean Values of elastic modulus of the left and right middle scalene muscles in each group(P>0.05);there were no significant differences between the cross-sectional area of the left and right anterior scalene muscles as well as the cross-sectional area of the left and right posteromedial scalene muscles in each group(P>0.05);and the elastic modulus and cross-sectional area of the posteromedial scalene muscles were significantly higher than those of the anterior scalene muscles in both groups(P<0.01,P<0.001).The mean Values of elastic modulus of the anterior and posteromedial scalene muscles were higher in the test group than in the control group in the neutral and lateral neck flexion positions(P<0.001),while the cross-sectional areas of the anterior and posteromedial scalene muscles were lower than those in the control group(P<0.01,P<0.001).To conclude,real-time shear wave elastography can be used to visually evaluate the differences in the mean Values of elastic modulus of the anterior and posteromedial scalene muscles in different states of the neck muscles in patients with neck and shoulder pain,whose bilateral scalene muscles are in a state of strain and stiffness.