超声引导下注射A型肉毒毒素联合康复训练治疗尖足畸形脑瘫患儿下肢痉挛的疗效观察  

Ultrasound-guided botulinum toxin type A injection combined with rehabilitation therapy on plantarflexion deformity caused by lower limbs spasticity in children with cerebral palsy： A clinical efficacy observation

作　　者：周陶成[1] 童光磊[1] 李飞[2] 张敏[1] 李司南[1] 李红[1] 易昕[1] 董文旭[1] 蔡云飞[1] 

机构地区：[1]安徽省立儿童医院康复科,合肥230051 [2]安徽中医药大学第二附属医院康复科

出　　处：《中华物理医学与康复杂志》2014年第5期345-348,共4页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：安徽省卫生厅课题（20088074）;安徽省卫生厅中医药管理局课题（2012zy63）

摘　　要：目的观察超声引导下注射A型肉毒毒素（BTX—A）联合康复训练治疗尖足畸形脑瘫患儿下肢痉挛的疗效。方法选取因下肢痉挛导致尖足的脑瘫患儿47例，按照随机数字表法将其分为注射组（24例）和对照组（23例），2组均给予康复训练，注射组在此基础上辅以超声引导下BTX—A注射。治疗前及治疗2周后、1个月后、3个月后、6个月后分别采用改良Ashworth量表（MAS）、踝关节被动活动度（PROM）和粗大运动功能测试量表-88（GMFM-88）对患儿下肢痉挛程度进行综合评定。结果治疗前，注射组患儿MAS评分[（3．31±0．76）分]、PROM值[（108．27±11．38）。]、GMFM-88评分[（54．31±10．31）分]与对照组患儿MAS评分[（3．40±0．65）分]、PROM值[（106．10±11．44）。]、GMFM-88评分[（55．62±10．22）分]比较，差异均无统计学意义（P〉0．05）。注射组治疗2周后、1个月后、3个月后、6个月后各指标与治疗前比较，差异均有统计学意义（P〈0．05）。对照组除治疗2周后外，剩余时间点各指标与治疗前比较，差异有统计学意义（P〈0．05），与注射组同时间点比较，对照组各指标差异均有统计学意义（P〈0．05）。结论超声引导下注射BTX—A联合康复训练可快速改善尖足畸形脑瘫患儿的下肢痉挛，值得临床应用、推广。Objective To observe the clinical efficacy of ultrasound-guided botulinum toxin type A （BTX-A） injection combined with rehabilitation therapy on plantarflexion deformity in cerebral palsy （CP） children with lower limbs spasticity. Methods Forty-seven CP children with plantarflexion deformity caused by lower limb spasticity were selected, and were divided into injection group （24 cases） and control group （23 cases） according to the random number table. Both groups were given rehabilitation therapy. The injection group received ultrasound- guided BTX-A injection as an addition. All children were given comprehensive assessment of lower limb spasticity before BTX-A treatment and 2 weeks, 1 month,3 months and 6 months after the treatment by use of the modified Ashworth scale （MAS） , ankle passive range of motion （PROM） and gross motor function measurement scale-88 （GMFM-88） D area （standing） and E area（walking, running and jumping）. Results At baseline, there were not significantly differences between the two groups in terms of MAS, PROM and GMFM-88 （ P 〉 0.05 ）. At 2 weeks, 1 month, 3 months and 6 months after the treatment, the injection group improved significantly with regard to all the parameters when compared to the baseline （P 〈 0.05 ）. The control group also improved with all the pa- rameters at 1, 3 and 6 months after the treatment （ P 〈 0.05 ）. It was also shown that the injection group improved to a significantly greater extent than the control group at all the time points after treatment with regard to all the as- sessment parameters （P 〈0.05）. Conclusion Ultrasound-guided BTX-A injection combined with rehabilitation therapy can quickly relieve the plantarflexion deformity in CP children. It is worthy of clinical application and promotion.

关 键 词：肉毒毒素 超声 脑性瘫痪 下肢痉挛 尖足 康复治疗 

分 类 号：R742.3[医药卫生—神经病学与精神病学]