高频超声与电刺激联合引导注射A型肉毒素治疗脑卒中后上肢痉挛的疗效分析  

Therapeutic effect analysis of high-frequency ultrasound combined with electrical stimulation guided injection of type A botulinum toxin in treatment of upper limb spasms after stroke

作　　者：郑直 程伟波 韩雨农 朱林丽 李文 李杜娟 Zheng Zhi;Cheng Weibo;Han Yunong;Zhu Linli;Li Wen;Li Dujuan(Department of Ultrsonography,the Second Affiliated Hospital of Wannan Medical College,Wuhu,Anhui 241000,China;Rehabilitation Medicine Department,the Second Affiliated Hospital of Wannan Medical College,Wuhu,Anhui 241000,China)

机构地区：[1]皖南医学第二附属医院超声医学科,安徽芜湖241000 [2]皖南医学第二附属医院康复医学科

出　　处：《齐齐哈尔医学院学报》2024年第14期1341-1345,共5页Journal of Qiqihar Medical University

基　　金：皖南医学院第二附属医院院级科研项目(YK2023Z03)。

摘　　要：目的探讨徒手定位、高频超声引导、高频超声联合电刺激引导下注射A型肉毒素治疗脑卒中后上肢痉挛性偏瘫患者的临床疗效。方法选择2021年12月—2023年12月本院康复医学科收治的确诊为脑卒中后上肢痉挛性偏瘫患者20例作为研究对象,随机分为徒手定位组(即触诊定位后盲穿,n=5)、高频超声引导组(即在高频超声引导下穿刺,n=7)和高频超声联合电刺激组(即先在高频超声引导下进针再用电刺激仪确认位置,n=8)共三组。所有患者均注射A型肉毒素于指浅屈肌、指深屈肌、桡侧腕屈肌、尺侧腕屈肌、拇长屈肌。在治疗前、治疗后4周、治疗后8周进行运动功能评定:Brunnstorm分级、改良Ashworth量表(MAS),ADL评分。结果组内比较,高频超声联合电刺激组在治疗4周时Brunnstorm分级、改良Ashworth量表(MAS)、ADL评分均比治疗前改善(P<0.05)。三组在治疗8周时Brunnstorm分级、改良Ashworth量表(MAS)和ADL评分均比治疗前改善(P<0.05);组间比较,徒手定位组与高频超声联合电刺激组之间比较:两组患者在治疗4周后ADL评分的改善值比较有显著差异(P<0.01);两组患者在治疗8周后改良Ashworth量表(MAS)、ADL评分的改善值比较有显著差异(P=0.049,P<0.01);高频超声引导组与高频超声联合电刺激组之间比较:两组患者在治疗4周及8周后ADL评分的改善值比较有显著差异(4周:P=0.04,8周:P<0.01)。结论三种注射方法均可以改善患者的上肢痉挛性偏瘫状态,高频超声联合电刺激引导的疗效优于徒手定位和高频超声引导。Objective To compare the clinical efficacy of naked hand positioning,high-frequency ultrasound guidance,high-frequency ultrasound combined with electrical stimulation guided injection of botulinum toxin type A in the treatment of the patients with spastic hemiplegia of upper extremities after stroke.Methods From December 2021 to December 2023,20 patients diagnosed with upper limb spastic hemiplegia after stroke in the department of rehabilitation medicine of our hospital were enrolled as the study subjects,and they were randomly divided into 3 groups.The naked hand positioning group(blind puncture after palpation and positioning,n=5),the high-frequency ultrasound guidance group(punctured under high-frequency ultrasound guidance,n=7),and the high-frequency ultrasound combined with electrical stimulation group(first enter the needle under high-frequency ultrasound guidance and then confirm the position with an electrical stimulator,n=8).All three groups of patients were injected with botulinum toxin type A into superficial flexor digits,deep flexor fingers,flexor carpal longus radial,flexor longum carpalus longus,and flexor pollicis longus.Motor function assessment was conducted before treatment,4 weeks after treatment,and 8 weeks after treatment:Brunnstorm grade,Modified Ashworth Scale(MAS),ADL score.Results Inner group comparison,the Brunnstorm grade,modified Ashworth scale(MAS),and ADL scores in the high-frequency ultrasound combined with electrical stimulation group were improved compared with those before treatment at 4 weeks of treatment(P<0.05).At 8 weeks of treatment,the Brunstorm score,modified Ashworth scale(MAS),and ADL score of the three groups were improved compared to those before treatment(P<0.05).Between groups,there was a significant difference in the improvement of ADL scores between between the naked hand positioning group and the high-frequency ultrasound combined with electrical stimulation group after 4 weeks of treatment(P<0.01).After 8 weeks of treatment,there were significant differences in

关 键 词：高频超声 电刺激 A型肉毒素 痉挛性偏瘫 

分 类 号：R743.3[医药卫生—神经病学与精神病学]