探究肌肉超声在严重烧伤患者肌肉性能评估中应用的效果观察。

回顾性分析2020年3月至2022年4月武汉大学同仁医院暨武汉市第三医院烧伤科符合入选标准的32例烧伤患者，其中男28例，女4例，年龄29~64(44±8)岁。烧伤面积40%~87%(57.34%±13.09%)TBSA, Ⅲ°烧伤面积4%~66%(27.50%±15.70%)TBSA。致伤原因：化学烧伤11例(34.4%)，火焰烧伤15例(46.9%)，热液烫伤6例(18.7%)。于入院时、伤后6周、伤后12周采用B型超声诊断仪进行股四头肌最小压力肌肉厚度测量、股四头肌最大压力肌肉厚度测量及股直肌横截面积测量。采用便携式肌力测试仪测量患者最大肌肉力量。对股四头肌各超声参数测量的可信性进行分析。采用Pearson相关分析及Spearman相关性分析对股四头肌超声参数与肌肉力量进行相关性分析。

不同时间点肌肉超声测量股四头肌的超声参数ICC值为0.914~0.997，均大于0.9，具有高可信性。入院时股四头肌最小压力肌肉厚度与肌肉力量存在弱正相关(r＝0.457，P＝0.009)，股四头肌最大压力肌肉厚度及股直肌横截面积与肌肉力量均不存在相关性(r＝0.318，P＝0.076；r＝0.310，P＝0.084)；伤后6周股四头肌最小压力肌肉厚度与肌肉力量呈中度正相关(r＝0.565，P＝0.001)，股四头肌最大压力肌肉厚度与肌肉力量呈弱正相关(r＝0.470，P＝0.007)，股直肌横截面积与肌肉力量呈高度正相关(r＝0.799，P<0.001)；伤后12周股四头肌最小压力肌肉厚度与肌肉力量呈中度正相关(r＝0.671，P<0.001)，股四头肌最大压力肌肉厚度与肌肉力量呈弱正相关(r＝0.486，P＝0.016)，股直肌横截面积与肌肉力量呈高度正相关(r＝0.781，P<0.001)。

严重烧伤患者股四头肌肌肉超声相关参数与肌肉力量具有良好的相关性，可以用于评价肌肉性能。在患者无法主观配合，肌肉力量测量不能客观反映其肌肉性能时，肌肉超声可作为肌肉性能评估的补充，但二者结合更为精准。

To investigate the application of muscle ultrasound in the assessment of muscle performance in patients with severe burns.

Thirty-two burn patients, including 28 males and 4 females, aged 29-64(44±8)years, who met the inclusion criteria in the burn unit of Tongren Hospital of Wuhan University and the Third Hospital of Wuhan from March 2020 to April 2022 were retrospectively analyzed. The burn area was 40%-87%(57.34%±13.09%) TBSA, Ⅲ° burns were 4%-66%(27.50%±15.70%) TBSA, and the causes of injury were chemical burns in 11 cases (34.4%), flame burns in 15 cases (46.9%), and hot liquid burns in 6 cases (18.7%). The minimum pressure muscle thickness measurement of quadriceps, maximum pressure muscle thickness measurement of quadriceps, and cross-sectional area measurement of rectus femoris were performed at admission, 6 weeks post-injury, and 12 weeks post-injury using a B-type ultrasound diagnostic instrument. A portable muscle strength tester was used to measure the patient's maximum muscle strength. Reliability analysis of the measurement of each ultrasound parameter of the quadriceps muscle was performed. Pearson correlation analysis and Spearman correlation analysis were used to correlate the quadriceps ultrasound parameters with muscle strength.

The ICC values of the ultrasound parameters of the quadriceps muscle measured by muscle ultrasound at different times ranged from 0.914 to 0.997, all of which were greater than 0.9 with high reliability. There was a weak positive correlation between quadriceps minimum pressure muscle thickness and muscle strength at admission (r=0.457, P=0.009), and no correlation between quadriceps maximum pressure muscle thickness and rectus femoris cross-sectional area and muscle strength (r=0.318, P=0.076; r=0.310, P=0.084). At 6 weeks post-injury, quadriceps minimum pressure muscle thickness was moderate positively correlated with muscle strength (r=0.565, P=0.001), quadriceps maximum pressure muscle thickness was weak positively correlated with muscle strength (r=0.470, P=0.007), rectus femoris cross-sectional area was high positively correlated with muscle strength (r=0.799, P<0.001). At 12 weeks post-injury, quadriceps minimum pressure muscle thickness showed a moderate positive correlation with muscle strength (r=0.671, P<0.001), quadriceps maximum pressure muscle thickness showed a weak positive correlation with muscle strength (r=0.486, P=0.016), rectus femoris cross-sectional area showed a high positive correlation with muscle strength (r=0.781, P<0.001).

Ultrasound-related parameters of quadriceps muscle in patients with severe burns have good correlation with muscle strength and can be used to evaluate muscle performance. For patients who can't cooperate subjectively and whose muscle strength measurements can't objectively reflect their muscle performance, muscle ultrasound can be used as a supplement tool to assess muscle performance, but the combination of them is more accurate.