A型肉毒毒素注射治疗与体外冲击波疗法治疗脑卒中后上肢痉挛的对比研究  

Comparative study of toxin type A injection therapy and extracorporeal shock wave therapy in treatment of upper limb spasticity after stroke

作　　者：李文 李杜娟 王锋 LI Wen;LI Du-juan;WANG Feng(Department of Rehabilitation Medicine,The Second Hospital of Wannan Medical College,Wuhu 241000,Anhui,China)

机构地区：[1]皖南医学院第二附属医院康复医学科,安徽芜湖241001

出　　处：《生物医学工程与临床》2025年第2期225-232,共8页Biomedical Engineering and Clinical Medicine

基　　金：2023年度芜湖市卫生健康委科研项目(WHWJ2023z006);安徽省教育厅高校2024年度自然科学研究项目(2024AH051924);皖南医学院2023年度校级重点项目科研基金(WK2023ZZD35)。

摘　　要：目的探讨A型肉毒毒素(BTX-A)注射治疗与体外冲击波(ESW)疗法治疗脑卒中后上肢痉挛的有效性及安全性,并进一步比较两者的疗效差异。方法选择104例脑卒中后上肢痉挛患者,其中男性51例,女性53例;年龄51~70岁,平均年龄59.86岁;体质量50~80 kg,平均体质量65.60 kg;身高153~175 cm,平均身高162.81 cm;病程3~8个月,平均病程5.45个月。随机分为BTX-A组(n=34)、ESW组(n=35)及Ctrl组(n=35)。Ctrl组接受常规康复治疗,BTX-A组在Ctrl组基础上增加超声联合电刺激定位下BTX-A注射治疗,ESW组在Ctrl组基础上增加ESW疗法。分别在治疗前、治疗4周后测量患侧上肢肱二头肌杨氏模量值(Emean),采用上肢改良Ashworth量表(MAS)评分对痉挛分级,评估患者患侧屈腕肌群及屈肘肌群的痉挛程度,并通过Fugl-Meyer上肢运动功能评价(FMA-UE)、改良Barthel指数(MBI)评估患者运动能力。结果治疗前3组患者肱二头肌Emean值、上肢屈腕肌群及屈肘肌群MAS评分、FMA-UE评分、MBI评分组间差异均无统计学意义(P>0.05)。治疗后,3组患者屈腕肌群、屈肘肌群MAS评分均较治疗前降低[Ctrl组屈腕肌群MAS评分:(2.66±0.54)分vs(3.06±0.68)分;屈肘肌群MAS评分:(2.66±0.54)分vs(3.11±0.63)分。BTX-A组屈腕肌群MAS评分:(1.91±0.62)分vs(3.12±0.64)分;屈肘肌群MAS评分:(1.71±0.63)分vs(3.09±0.67)分。ESW组屈腕肌群MAS评分:(1.91±0.56)分vs(3.09±0.70)分;屈肘肌群MAS评分:(1.86±0.65)分vs(3.14±0.65)分。P<0.05],FMA-UE评分、MBI评分均较治疗前提高[Ctrl组FMA-UE评分:(34.69±2.13)分vs(25.74±1.54)分;MBI评分:(63.80±2.01)分vs(54.80±2.37)分。BTX-A组FMA-UE评分:(37.82±1.91)分vs(25.97±1.83)分;MBI评分:(70.18±2.32)分vs(55.15±1.99)分。ESW组FMA-UE评分:(37.31±2.11)分vs(25.69±1.39)分;MBI评分:(70.71±2.16)分vs(55.00±1.55)分。P<0.05]。与Ctrl组相比,BTX-A组和ESW组治疗后屈腕肌群及屈肘肌群MAS评分、FMA-UE评分、MBI评分差异有统计学意义(P<0.05),但BTObjective To investigate the efficacy and safety of botulinum toxin type A(BTX-A)injection therapy and extracorporeal shock wave(ESW)therapy in treatment of upper limb spasticity after stroke,and further compare the differences of their therapeutic effects.Methods A total of 104 patients with upper limb spasticity after stroke were enrolled,which included 51 males and 53 females,aged 51-70 years old with mean age of 59.86 years old;body mass was 50-80 kg with mean body mass of 65.60 kg;height was 153-175 cm with mean height of 162.81 cm;disease course was 3-8 months with mean course of 5.45 months.All of them were randomly divided into BTX-A group(n=34),ESW group(n=35)and Ctrl group(n=35).The Ctrl group received routine rehabilitation treatment,BTX-A group was treated with BTX-A injection under ultrasound combined with electrical stimulation positioning on the basis of Ctrl group,and ESW group performed ESW therapy on the basis of Ctrl group.The Young’s module(Emean)of biceps brachii at affected upper limb was measured before and after 4-week of treatment.The modified Ashworth scale(MAS)score of upper limb was used to grade spasticity and evaluate spasticity of wrist flexor muscles and elbow flexor muscles on affected side,and motor ability was evaluated by Fugl-Meyer upper limb motor function evaluation(FMA-UE)and modified Barthel index(MBI).Results Before treament,there was no significant difference in Emean of biceps brachii,MAS score of flexor wrist muscles and flexor elbow muscles,FMA-UE score and MBI among 3 groups(P>0.05).After treatment,MAS scores of flexor wrist muscles and flexor elbow muscles in 3 groups were lower than those of before treatment[MAS score of flexor wrist muscles in Ctrl group:(2.66±0.54)scores vs(3.06±0.68)scores;MAS score of elbow flexion muscles:(2.66±0.54)scores vs(3.11±0.63)scores.MAS score of elbow flexion muscles in BTX-A group:(1.91±0.62)scores vs(3.12±0.64)scores;MAS score of elbow flexion muscles:(1.71±0.63)scores vs(3.09±0.67)scores.MAS score of flexor wrist muscles

关 键 词：脑卒中 偏瘫 上肢痉挛 A型肉毒毒素 体外冲击波 

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