A型肉毒毒素对脑卒中患者胫神经F波和步行能力的影响
A형육독독소대뇌졸중환자경신경F파화보행능력적영향
Effects of botulinum toxin type A on the F-wave of the tibial nerve and the walking ability of stroke patients
  • 万方数据
    中华物理医学与康复杂志 중화물리의학여강복잡지
    CHINESE JOURNAL OF PHYSICAL MEDICINE AND REHABILITATION
    2013年 2期 119-122 ,共4页

    宋涛%龙丽华%李辉萍

    송도%룡려화%리휘평

    肉毒毒素%脑卒中%步行能力%肌电图 肉毒毒素%腦卒中%步行能力%肌電圖
    육독독소%뇌졸중%보행능력%기전도
    Botulinum toxin%Stroke%Walking ability%Electromyography
    目的 探讨小腿三头肌局部A型肉毒毒素(BTX-A)注射对脑卒中患者胫神经F波和步行能力的影响.方法 选择20例脑卒中偏瘫下肢痉挛患者,按患者意愿和治疗方式的不同分为实验组和对照组,每组10例.所有患者均接受为期4周的步行训练、平衡训练、肌力训练等常规康复治疗；在康复治疗前,实验组在电刺激引导下接受患侧下肢腓肠肌和比目鱼肌BTX-A注射治疗,总剂量300 IU,BTX-A注射只进行1次.选择患侧下肢胫神经行F波检测,使用改良式Ashworth量表评定肌张力,起立步行测试和10 m自由步行测试评价患者步行能力,并进行统计学分析比较.结果 ①治疗前,实验组和对照组的胫神经F波波幅分别为(387.8±48.7)μV和(375.6±56.6)μV,2组的F/M值分别为(31.4±5.6)％和(28.6±5.4)％,2组间差异均无统计学意义(P＞0.05)；实验组患者治疗2周后的胫神经F波波幅和F/M值均较治疗前明显降低(P＜0.05),而对照组下降不明显(P＞0.05)；治疗2周后和治疗4周后,2组间同时间点的比较,差异有统计学意义(P＜0.05).②治疗前,实验组与对照组患者小腿三头肌肌张力评分分别为(3.76±0.67)分和(3.86±0.54)分,2组间差异无统计学意义(P＞0.05)；治疗4周后,实验组患者小腿三头肌肌张力评分为(1.87±0.87)分,较治疗前明显下降(P＜0.05),而对照组患者小腿三头肌肌张力评分为(3.36±0.87)分,较治疗前略有下降(P＞0.05),但2组间同时间点比较,差异有统计学意义(P＜0.05).③治疗前,实验组和对照组的TUG测试时间分别为(45.6 ±7.5)s和(46.4±8.9)s,2组患者10 m自由步行测试时间分别为(44.6±8.4)s和(43.8 ±9.1)s,组间差异无统计学意义(P＞0.05)；治疗4周后,实验组患者的TUG和10 m自由步行测试时间分别为(24.1±10.3)s和(24.5±9.8)s,较治疗前明显减少(P＜0.05),而对照组减少不明显(P＞0.05)；治疗4周后,实验组患者的TUG和10 m自由步行测试时间与对照组同时间点比较,差异有统计学意义(P＜0.05).结论 下肢局部注射肉毒毒素(BTX)可降低相应脊髓节段运动神经元的F波波幅,BTX注射结合康复训练治疗可以显著提高患者的步行能力.
    목적 탐토소퇴삼두기국부A형육독독소(BTX-A)주사대뇌졸중환자경신경F파화보행능력적영향.방법 선택20례뇌졸중편탄하지경련환자,안환자의원화치료방식적불동분위실험조화대조조,매조10례.소유환자균접수위기4주적보행훈련、평형훈련、기력훈련등상규강복치료；재강복치료전,실험조재전자격인도하접수환측하지비장기화비목어기BTX-A주사치료,총제량300 IU,BTX-A주사지진행1차.선택환측하지경신경행F파검측,사용개량식Ashworth량표평정기장력,기립보행측시화10 m자유보행측시평개환자보행능력,병진행통계학분석비교.결과 ①치료전,실험조화대조조적경신경F파파폭분별위(387.8±48.7)μV화(375.6±56.6)μV,2조적F/M치분별위(31.4±5.6)％화(28.6±5.4)％,2조간차이균무통계학의의(P＞0.05)；실험조환자치료2주후적경신경F파파폭화F/M치균교치료전명현강저(P＜0.05),이대조조하강불명현(P＞0.05)；치료2주후화치료4주후,2조간동시간점적비교,차이유통계학의의(P＜0.05).②치료전,실험조여대조조환자소퇴삼두기기장력평분분별위(3.76±0.67)분화(3.86±0.54)분,2조간차이무통계학의의(P＞0.05)；치료4주후,실험조환자소퇴삼두기기장력평분위(1.87±0.87)분,교치료전명현하강(P＜0.05),이대조조환자소퇴삼두기기장력평분위(3.36±0.87)분,교치료전략유하강(P＞0.05),단2조간동시간점비교,차이유통계학의의(P＜0.05).③치료전,실험조화대조조적TUG측시시간분별위(45.6 ±7.5)s화(46.4±8.9)s,2조환자10 m자유보행측시시간분별위(44.6±8.4)s화(43.8 ±9.1)s,조간차이무통계학의의(P＞0.05)；치료4주후,실험조환자적TUG화10 m자유보행측시시간분별위(24.1±10.3)s화(24.5±9.8)s,교치료전명현감소(P＜0.05),이대조조감소불명현(P＞0.05)；치료4주후,실험조환자적TUG화10 m자유보행측시시간여대조조동시간점비교,차이유통계학의의(P＜0.05).결론 하지국부주사육독독소(BTX)가강저상응척수절단운동신경원적F파파폭,BTX주사결합강복훈련치료가이현저제고환자적보행능력.
    Objective To explore the effects of botulinum toxin type A (BTX-A) on the F-waves of the tibial nerve and the walking ability of stroke patients.Methods Twenty stroke patients with spastic hemiplegia of a lower limb were randomly divided into experimental and control groups with 10 patients in each group.All received four weeks of conventional rehabilitation,including walking training,balance training and muscle strength training.In the experimental group,a total of 300 IU of BTX-A was injected into the gastrocnemius (200 IU) and soleus muscles (100 IU)before the start of routine rehabilitation,guided by using the electrical stimulation.Muscle tone was assessed using the modified Ashworth scale(MAS).Walking ability was assessed with the timed up and go test (TUGT) and a 10 m free walking test.F-wave parameters were recorded in the tibial nerve before,two weeks and four weeks after the injection.Results In the experimental group there was a significant difference in F-wave amplitude between those recorded before treatment and after two weeks of treatment.The control group showed no statistically significant difference.In experimental group there was also a statistically significant difference in triceps muscle tension before and after treatment which was not observed in the control group.Walking ability improved significantly in both groups.Conclusions Local injection of BTX-A into the lower limbs can reduce the F-wave amplitudes of spinal cord motor neurons.BTX-A injection combined with rehabilitation training can significantly improve the walking ability of stroke patients.
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