脑卒中后痉挛肌注射肉毒毒素的超声及电刺激与单独电刺激两种定位方法的比较  

Comparison between ultrasound combined with electrical stimulation -guidance and electrical stimulation -directing BTX -A injection in poststroke patients with spasticity

作　　者：杨远滨[1] 张倩[2] 王萍[2] 杜巨豹[1] 屈亚萍[1] 朱琳[1] 宋为群[1] 王茂斌[1] 

机构地区：[1]首都医科大学宣武医院康复医学科,100053 [2]首都医科大学宣武医院超声科

出　　处：《中国康复医学杂志》2008年第10期903-905,I0001,共4页Chinese Journal of Rehabilitation Medicine

摘　　要：目的:在肉毒毒素注射治疗卒中后下肢痉挛中,比较超声+电刺激与单独电刺激定位两种方法的效果。方法:选取40例脑卒中后偏瘫的患者,伴有一侧肢体痉挛,下肢以踝跖屈肌群痉挛为主,改良Ashworth评分(MAS)2级12例,3级20例,4级8例,按分级随机分入A、B两组,每组各级评分的人数相等,每组20例,分别给予小腿三头肌及胫后肌A型肉毒毒素注射治疗,A组以电刺激加超声引导下定位,B组单独以电刺激定位。注射后立即进行疼痛VAS评分,并于注射后2周对比MAS评分、步行速度。数据采用方差分析和t检验。结果:肉毒毒素注射后,小腿踝跖屈肌群MAS评分,A组为0.8±0.70,B组为1.4±0.94;步行速度A组0.36±0.13m/s,B组0.27±0.12m/s;VAS疼痛评分,A组5.71±1.04,B组6.66±1.32,经t检验,差异有显著性(P<0.05)。结论:应用在超声引导下加电刺激定位进行注射与以往常规单独电刺激定位进行注射相比,前者缓解肌张力的效果好,定位更加准确,避开血管、神经,减少出血,特别适用于儿童及疼痛敏感的患者,尤其是深部肌肉定位注射。Objective： To compare two localization methods between ultrasound （US） guidance combined with electrical stimulation （ES） directing and electrical stimulation-directing BTX-A injection in poststroke patients with spasticity. Method：Forty patients with spastic bemiplegia after stroke were involved. According to Modified Asbworth Scale （MAS） the patients included 12 cases at grade 2, 20 at grade 3 and 8 at grade 4. All patients were seperated into two groups randomly：Group A for US combined with ES guidance （20 cases）; Group B for ES directing （20 cases）. Muscle triceps surae and tibialis posterior of patients in each group were injected by different localization methods. VAS was assessed as soon as BTX-A injection finished for each patient; MAS and step velocity were evaluated after two weeks. Data were analyzed by Mean Square and t test. Result： The average MAS scores were 0.8±0.69585（group A） and 1.4±0.94032（group B） respectively. The average step velocity were 0.36±0.13ntis （Group A） and 0.27±0.12m/s （Group B） respectively. The VAS scores were 5.705±1.044 （group A） and 6.660±1.320 （group B） respectively. There was significant difference between two groups. Conclusion： BTX-A injection localized by US combined with ES is more accurate than by ES only, can get maximum effects in relieving poststroke spasticity with less pain, bleeding and avoid nerve injury during injection procedure, and is especially beneficial for children and adults who are sensitive to pain and for deeper muscles BTX-A injection.

关 键 词：脑卒中 痉挛 A型肉毒毒素 超声波引导 电刺激定位 注射 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R454.1[医药卫生—临床医学]