CAJ | 학술논문

目的观察肌电图联合电刺激引导注射A型肉毒毒素(BTX-A)治疗脑卒中后上肢痉挛的疗效.方法选取45例脑卒中后上肢痉挛患者,在肌电图及电刺激定位引导下,采用多点注射方式将A型肉毒毒素注入痉挛靶肌内；并于注射A型肉毒毒素后辅以肢体功能训练.于注射前、注射后第1周、第2周、1个月、3个月时分别采用改良Ashworth痉挛量表(MAS)、简式Fugl-Meyer运动功能量表(FMA)上肢部分、腕指关节主动活动度(AROM)及改良Barthel指数评分(MBI)对所有患者进行疗效评定.结果注射A型肉毒毒素第2周、1个月和3个月后,发现患肢肌张力、上肢FMA运动功能评分、腕指关节AROM及MBI评分均较注射前明显改善(P＜0.05)；并且注射后1个月时患者上肢FMA评分[(20.82±2.81)分]、腕指关节AROM[伸腕(9.45±1.97)°,伸指(9.82±2.54)°]较注射后第2周时显著提高(P＜0.05)；注射后3个月时患者上肢FMA评分[(23.93±3.15)分]、腕指关节AROM[伸腕(12.57±2.52)°,伸指(11.28±3.09)°]较注射后1个月时亦有明显改善(P＜0.05)；整个治疗期间入选患者均未发生明显副反应.结论于肌电图及电刺激联合引导下注射A型肉毒毒素治疗脑卒中后上肢痉挛患者具有定位准确、疗效显著、安全有效、副反应少等优点,该疗法值得临床推广、应用.
목적 관찰기전도연합전자격인도주사A형육독독소(BTX-A)치료뇌졸중후상지경련적료효.방법 선취45례뇌졸중후상지경련환자,재기전도급전자격정위인도하,채용다점주사방식장A형육독독소주입경련파기내；병우주사A형육독독소후보이지체공능훈련.우주사전、주사후제1주、제2주、1개월、3개월시분별채용개량Ashworth경련량표(MAS)、간식Fugl-Meyer운동공능량표(FMA)상지부분、완지관절주동활동도(AROM)급개량Barthel지수평분(MBI)대소유환자진행료효평정.결과 주사A형육독독소제2주、1개월화3개월후,발현환지기장력、상지FMA운동공능평분、완지관절AROM급MBI평분균교주사전명현개선(P＜0.05)；병차주사후1개월시환자상지FMA평분[(20.82±2.81)분]、완지관절AROM[신완(9.45±1.97)°,신지(9.82±2.54)°]교주사후제2주시현저제고(P＜0.05)；주사후3개월시환자상지FMA평분[(23.93±3.15)분]、완지관절AROM[신완(12.57±2.52)°,신지(11.28±3.09)°]교주사후1개월시역유명현개선(P＜0.05)；정개치료기간입선환자균미발생명현부반응.결론 우기전도급전자격연합인도하주사A형육독독소치료뇌졸중후상지경련환자구유정위준학、료효현저、안전유효、부반응소등우점,해요법치득림상추엄、응용.
Objective To investigate the clinical effect of botulinum toxin type A (BTX-A) injections guided by electromyography in combination with electrical stimulation in the treatment of upper limb spasticity poststroke.Methods Forty-five patients with upper limb spasticity following stroke were recruited.They received multiple intra-muscular BTX-A injections guided by electromyography and electrical stimulation.Rehabilitation training was administered after the BTX-A injections.The results were assessed using the modified Ashworth scale (MAS),the Fugl-Meyer upper limb assessment (FMA),active range of movement (AROM) and the modified Barthel index (MBI).All the assessments were performed at the baseline,and then 1 week,2 weeks,1 month,and 3 months after the injections.Results Compared with the baseline scores the MAS,FMA,AROM and MBI results had all obviously improved by 2 weeks after the BTX-A injections.Compared with 2 weeks after the injections,the FMA and AROM scores at 1 month were significantly higher and there were further significant improvements at 3 months.No patient demonstrated obvious side effects from the therapy.Conclusion BTX-A injection guided by electromyography and electrical stimulation is safe and has definite beneficial effects on upper limb spasticity after stroke.