A型肉毒毒素联合冲击波疗法对脑卒中后下肢痉挛状态的疗效观察  

The effect of botulinum toxin type A combined with extracorporeal shock wave therapy on spasticity of lower limbs in stroke patients

作　　者：王虹[1] 赵晨光[1] 袁华[1] 刘卫[1] 袁鸿儒 惠楠[1] 牟翔[1] WANG Hong ZHAO Chenguang YUAN Hua et al(Xijing Hospital,the Fourth Military Medical University, Xi＇an, Shanxi, 710032)

机构地区：[1]第四军医大学附属西京医院,陕西西安710032

出　　处：《中国康复医学杂志》2017年第7期773-778,共6页Chinese Journal of Rehabilitation Medicine

基　　金：国家科技部国际合作项目(2013DFA32610);国家自然科学基金项目(81271450);陕西省国际合作与交流项目(2015KW-035)

摘　　要：目的:观察A型肉毒毒素(BTX-A)注射联合体外冲击波疗法(ESWT)对脑卒中后下肢肌肉痉挛状态的疗效和安全性。方法:共选取60例脑卒中患者,均伴有下肢肌肉痉挛(小腿三头肌痉挛为主),随机分为常规治疗组、常规治疗+BTXA治疗组、常规治疗+BTX-A+ESWT治疗组,每组各20例患者。常规治疗组(A组)采用各种常规康复训练方法,每日1次,每周6次,共治疗4周;常规治疗+BTX-A组(B组)的患者除了进行常规康复治疗外,还对小腿痉挛肌肉进行BTX-A注射;而常规治疗+BTX-A+ESWT组(C组)除了进行常规康复治疗及局部注射BTX-A外,还给予患者小腿三头肌进行EWST治疗,每周1次,治疗4周。治疗前和治疗后1周、4周和16周分别进行踝关节跖屈肌群肌张力、下肢运动功能以及日常生活活动(ADL)能力评定。结果:(1)肌张力变化情况:三组患者治疗1周后,与治疗前相比,A组和B组略有下降、但是C组肌张力显著性降低(P<0.05)。4周后,A、B、C组肌张力均显著性下降(P<0.05),而B组、C组较A组效果更为佳(P<0.05)。16周随访,A、B、C组肌张力均有所回升,但B、C组肌张力较治疗前仍降低(P<0.05),且C组优于B组(P<0.05)。(2)运动及ADL能力变化情况:三组患者治疗1周后,A、B、C组患者的运动功能及ADL能力无明显改善;4周后,三组运动功能和ADL能力均有所改善(P<0.05),B组、C组改善较A组更好(P<0.05)。而16周时,A组、B组运动功能和ADL能力出现下降,B组、C组相比虽有下降,但仍优于A组(P<0.05)。结论:A型肉毒毒素联合冲击波疗法可以迅速并且较持久地降低患者肌张力,也能够有效地提高患者的运动功能和ADL能力,对脑卒中后肢体痉挛有明显改善作用。Objective： To observe the efficacy and safety of botulinum toxin type A （BTX-A） injection combined with extracorporeal shock wave therapy （ESWT） in the treatment of lower limb muscle spasm after stroke. Method： A total of 60 stroke patients associated with lower extremity muscle spasms （triceps spasm） were enrolled in this study, and were randomly divided into routine treatment group, routine treatment＋BTX-A treatment group and routine treatment＋BTX-A＋ESWT treatment group, with 20 patients in each group. The routine treatment group （group A） was given various conventional methods of rehabilitation training（1 times a day, 6 times a week, a total of 4 weeks of treatment）, conventional treatment ＋BTX-A group （group B） the patients were given conventional rehabilitation treatment and BTX-A injection on muscle and leg cramps as well,routine treatment ＋BTX-A ＋ESWT group （group C） were given routine rehabilitation therapy, local injection of BTX-A and triceps EWST treatment（1 times a week for 4 weeks）. Muscle tension, function of movement in lower limb and activity of daily life （ADL） were assessed at the 1St week, 4st week and 16st week after treatment. Result： ①After 1 week of treatment, group A and B had no obvious changes, while the degree of muscle tension in groups C decreased significantly （P〈0.05）. After 4 weeks, muscle tension of all three groups decreased （P〈0.05）. Group B and group C had better results than group A （P〈0.05）. After 16 weeks follow-up, three groups of muscle tension all increased, but the muscle tension in group B and group C is still lower than the other two groups （P〈0.05）, and group C is better than group B （P〈0.05）.②After 1 weeks of treatment, function of movement and activity of daily life in the three groups had no obvious improvement. After 4 weeks of treatment, function of movement and activity of daily life in three groups were improved （P〈0.05） with more significant improvement in group B and

关 键 词：脑卒中 痉挛状态 A型肉毒毒素 体外冲击波疗法 

分 类 号：R743.3[医药卫生—神经病学与精神病学]