肌构筑学原理在A型肉毒毒素治疗脑卒中后痉挛中的应用  

Role of Architecture of the Human Muscle in Treatment of Spasticity after Stroke with BTX-A

作　　者：杨远滨[1] 屈亚平[1] 王茂彬[1] 

机构地区：[1]首都医科大学宣武医院康复科,北京市100053

出　　处：《中国康复理论与实践》2007年第11期1050-1051,共2页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的观察肌构筑学原理在A型肉毒毒素治疗脑卒中后痉挛中的应用。方法40例脑卒中后偏瘫患者,伴有上肢屈肌、下肢伸肌痉挛,改良Ashworth评分3级以上,分为观察组和对照组各20例,进行屈腕肌和小腿三头肌A型肉毒毒素注射,观察组应用肌构筑学原理对肌群之间的药物剂量进行分配和注射点数确定,对照组是依照常规注射参考剂量和注射点数。均以神经刺激器辅助定位进行注射,并注射后2周对比两组改良Ashworth评分及支具穿戴情况。结果肉毒毒素注射后改良Ashworth评分:上肢掌屈肌观察组为(1.3±0.9234),对照组为(1.9±0.8522);下肢小腿三头肌观察组为(1.6±0.8826),对照组为(2.25±0.7864),均有显著性差异(P<0.05)。治疗后,上肢不用支具观察组为10例,对照组为6例;下肢不用支具观查组为8例,对照组为4例,均无显著性差异(P>0.05)。结论应用肌构筑学原理确定各肌群的A型肉毒毒素剂量和注射点数较以常规注射方法能更有效缓解肌张力,但对支具的穿戴影响不明显。Objective To explore the role of architecture of the human muscle in treatment of spasticity after stroke with BTX. Methods 40 patients with spasticity hemiplegia after stroke were involved, whose scores of Modified Ashworth Scale beyond 3. They were divided in 2 groups： control group and observed group, in which BTX dose and injection points designed without or with architecture of the human muscle. All muscles injected were located with electrical stimulator. They were evaluated with Modified Ashworth Scale and the incidence of brace wearing were observed 2 weeks after treatment. Results The Ashworth scores for wrist flexors were （1.3±0.9234） in observedgroup,（1.9±0.8522） in control group （P〈0.05）; for the triceps surae, they were （1.6± 0. 8826） and （2.25±0. 7864） respectively （P〈0.05）. 10 cases wore brace for upper limbs in observed group and 14 cases in control group; for the brace for lower limbs, there were 12 in observed group and 16 in control group （P〉0.05）. Conclusion BTX dose and injection points designed by Architecture of the Human Muscle in Treatment of spasticity after stroke is better than routine way, but the brace wearing for patients showed no significant improvement.

关 键 词：脑卒中 痉挛 A型肉毒毒素(BTX-A) 肌构筑学 治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]