超声实时组织弹性成像在婴幼儿肌性斜颈早期诊治中的应用研究

摘要

Objective To discuss the applied value of ultrasound real-time elastography (RTE) in early diagnosis of congenital muscular torticollis (CMT) in infants.Methods Three hundred and thirty-six infants with CMT under 3-year-old were received the conventional ultrasound and RTE examination on their diseased sternocleidomastoid (SCM).And then a retrospective analysis was carried out by comparing the examination result with clinical observation and surgical pathology.Results The ultrasound performance of these 336 infants were divided into mass type (251 cases,75％),and diffuse type (85 cases,25％).RTE score for healthy side was grade Ⅰ;RTE scores for unhealthy side was grade Ⅱ in 97 cases,grade Ⅲ in 186 cases,and grade Ⅳ in 53 cases,respectively.Strain ration (SR) for mass type was 0.76-4.42,and for diffuse type was 1.49-7.07.By regarding pathological result as the standard,ROC curve was constructed to determine the best operation opportunity guided by ultrasound,SR 3.35 was a critical point of operative and nonoperative treatment (sensitivity 87.7％,specificity 98.2％,accuracy 96.1％).By using RTE dynamic observation,272 cases (81％) with low RTE scoring of CMT got the effect by non-operative treatment and 64 cases (19％) with high RTE scoring of CMT were cured by operative treatment.Conclusions RTE can provide more objective semi-quantitative data about stiffness for SCM disease and it's helpful for making resonable clinical treatment plans and dynamically observing its efficacy.%目的 探讨超声实时组织弹性成像(RTE)在婴幼儿先天性肌性斜颈(CMT)早期诊治中的应用价值.方法 对336例3岁以下婴幼儿CMT患儿胸锁乳突肌(SCM)病变进行常规超声及RTE检查,并与临床观察治疗和手术病理结果对照分析.结果 ①常规超声表现为肿块型CMT 251例(75％),弥漫型CMT 85例(25％).②弹性评分健侧SCM评分均为1级,患侧SCM弹性评分2级97例,3级186例,4级53例.③弹性应变比值(SR)肿块型为0.76～4.42,弥漫型为1.49～7.07;以病理结果为标准,构建ROC曲线确定超声指导下患儿最佳手术时机,SR 3.35为非手术治疗与手术治疗的临界点,其敏感性为87.7％,特异性为98.2％,准确性为96.1％.④RTE动态观察疗效,272例(81％)病变组织弹性评分低者非手术治疗有效,64例(19％)病变组织弹性评分高者经手术治愈.结论 RTE在CMT早期诊治中作为常规超声的补充,可为SCM病变提供更为客观的半定量硬度信息,并指导临床制定合理的治疗方案及动态观察疗效.