电刺激定位肉毒素注射治疗肌痉挛的临床研究  

Clinical research on location by electrical stimulation guidance for botulinum toxin injection in the treatment of muscle spasticity

作　　者：陈庆梅[1] 孙海伟[1] 李莉[1] 张大伟[1] 杨卫新[1] 

机构地区：[1]苏州大学附属第一医院康复科,苏州215006

出　　处：《中国康复》2014年第6期442-446,共5页Chinese Journal of Rehabilitation

摘　　要：目的:观察电刺激定位在肉毒素注射中的临床价值。方法:脑卒中后肌痉挛患者45例,按痉挛部位分组,肱二头肌组分为电刺激定位组18例(A1组)采用电刺激定位法,徒手定位组17例(A2组)采用徒手定位法,下肢组分为电刺激定位组20例(B1组)及徒手定位组20例(B2组)。注射前后采用改良Ashworth评级(MAS)及表面肌电积分值(IEMG)评价肌张力,测量被动关节活动度(PROM)评定肘、踝跖屈曲活动度;运动功能评定量表(FMA)、10m步速评估下肢运动功能。结果:治疗后2、4、8及12周时,A1、A2组MAS及IEMG评分均较治疗前呈逐渐下降趋势(P<0.05),且A1组更低于A2组(P<0.05);治疗后,A1、A2组肘关节屈曲PROM及上肢FMA评分均较治疗前呈逐渐升高趋势(P<0.05),且A1组肘关节屈曲PROM在治疗后4、8及12周时较A2组提高更显著(P<0.05),A1组上肢FMA在治疗后8及12周时较A2组提高更显著(P<0.05)。治疗后2、4、8及12周时,B1、B2组MAS、IEMG评分及10m步行时间均较治疗前呈逐渐下降趋势(P<0.05),B1、B2组下肢踝关节跖屈PROM及下肢FMA评分均较治疗前呈逐渐升高趋势(P<0.05)且B1组下肢踝关节跖屈PROM在治疗后2周及下肢FMA在治疗后12周较B2组提高更显著(P<0.05),余各项评分及时间点2组间比较差异无统计学意义。结论:肱二头肌采用电刺激定位肉毒素注射临床治疗肌痉挛的临床效果优于徒手定位;比目鱼肌、腓肠肌及胫后肌采用电刺激定位肉毒素注射临床治疗肌痉挛的临床效果与徒手定位比较,差异无统计学意义。Objective：To observe the clinical value of electrical stimulation guidance for botulinum toxin injection. Methods： Forty-five stroke patients with spasm were selected. These patients were divided into the biceps brachii group and lower ex- tremity groups according to the different spasm parts. The patients in the biceps brachii group were assigned into electrical stimulation subgroup（subgroup A1）（n： 18） subject to electrical stimulation directing injection, and manual palpation-guided subgroup（subgroup A2）（n：17） to manual palpation-guided location. The patients in the lower extremity group were as- signed into electrical stimulation subgroup（group 131 ） （n = 20） and manual palpatiowguided subgroup （ group t32 ） （ n = 20）. Modified Ashworth Scate（MAS）, Intergrated EMG（IEMG）, Passive RanNe of Motion（PROM）, Fngl-Meyer Motor Func- tion Assessment（FMA） and speed of gait were applied before and after treatment. Results： In subgroups A1 and A2, the measurement indexes of MAS and IEMG showed a gradual decrease after treatment（P〈0. 05） ,and the indexes in subgroup A1 were lower than in subgroup A2（P〈0. 05）. In subgroups A1 and A2, the measurement indexes of PROM and FMA showed a gradual increase after treatment（P〈0. 05）, and the PROM at the 4th, 8th and 12th week, and the FMA at the 8th and 12th week after treatment in subgroup A1 were increased significantly as compared with subgroup A2（P〈0. 05）. In subgroups B1 and 132, the measurement indexes of MAS, IEMG and speed of gait showed a gradual decrease after treatment （P〈0. 05）,and PROM and FMA showed a gradual increase after treatment（P〈0. 05）. As compared with subgroup B2, the PROM at the 2nd,and the FMA at the 12th week in subgroup B1 were increased signifieantly（P〈0. 05）. There was no statistically significant difference in the variations of measurement indexes during follow-up periods between two groups. Conclusions：In biceps brachii, electrical stimulation location g

关 键 词：A型肉毒毒素 电刺激定位 徒手定位 

分 类 号：R685[医药卫生—骨科学]