CAJ | 학술논문

目的观察超声引导下注射A型肉毒毒素(BTX-A)联合康复训练治疗尖足畸形脑瘫患儿下肢痉挛的疗效.方法选取因下肢痉挛导致尖足的脑瘫患儿47例,按照随机数字表法将其分为注射组(24例)和对照组(23例),2组均给予康复训练,注射组在此基础上辅以超声引导下BTX-A注射.治疗前及治疗2周后、1个月后、3个月后、6个月后分别采用改良Ashworth量表(MAS)、踝关节被动活动度(PROM)和粗大运动功能测试量表-88(GMFM-88)对患儿下肢痉挛程度进行综合评定.结果治疗前,注射组患儿MAS评分[(3.3l±0.76)分]、PROM值[(108.27±11.38)°]、GMFM-88评分[(54.31±10.31)分]与对照组患儿MAS评分[(3.40±0.65)分]、PROM值[(106.10±11.44)°]、GMFM-88评分[(55.62±10.22)分]比较,差异均无统计学意义(P＞0.05).注射组治疗2周后、1个月后、3个月后、6个月后各指标与治疗前比较,差异均有统计学意义(P＜0.05).对照组除治疗2周后外,剩余时间点各指标与治疗前比较,差异有统计学意义(P＜0.05),与注射组同时间点比较,对照组各指标差异均有统计学意义(P＜0.05).结论超声引导下注射BTX-A联合康复训练可快速改善尖足畸形脑瘫患儿的下肢痉挛,值得临床应用、推广.
목적 관찰초성인도하주사A형육독독소(BTX-A)연합강복훈련치료첨족기형뇌탄환인하지경련적료효.방법 선취인하지경련도치첨족적뇌탄환인47례,안조수궤수자표법장기분위주사조(24례)화대조조(23례),2조균급여강복훈련,주사조재차기출상보이초성인도하BTX-A주사.치료전급치료2주후、1개월후、3개월후、6개월후분별채용개량Ashworth량표(MAS)、과관절피동활동도(PROM)화조대운동공능측시량표-88(GMFM-88)대환인하지경련정도진행종합평정.결과 치료전,주사조환인MAS평분[(3.3l±0.76)분]、PROM치[(108.27±11.38)°]、GMFM-88평분[(54.31±10.31)분]여대조조환인MAS평분[(3.40±0.65)분]、PROM치[(106.10±11.44)°]、GMFM-88평분[(55.62±10.22)분]비교,차이균무통계학의의(P＞0.05).주사조치료2주후、1개월후、3개월후、6개월후각지표여치료전비교,차이균유통계학의의(P＜0.05).대조조제치료2주후외,잉여시간점각지표여치료전비교,차이유통계학의의(P＜0.05),여주사조동시간점비교,대조조각지표차이균유통계학의의(P＜0.05).결론 초성인도하주사BTX-A연합강복훈련가쾌속개선첨족기형뇌탄환인적하지경련,치득림상응용、추엄.
Objective To observe the clinical efficacy of ultrasound-guided botulinum toxin type A (BTX-A) injection combined with rehabilitation therapy on plantarflexion deformity in cerebral palsy (CP) children with lower limbs spasticity.Methods Forty-seven CP children with plantarflexion deformity caused by lower limb spasticity were selected,and were divided into injection group (24 cases) and control group (23 cases) according to the random number table.Both groups were given rehabilitation therapy.The injection group received ultrasoundguided BTX-A injection as an addition.All children were given comprehensive assessment of lower limb spasticity before BTX-A treatment and 2 weeks,1 month,3 months and 6 months after the treatment by use of the modified Ashworth scale (MAS),ankle passive range of motion (PROM) and gross motor function measurement scale-88 (GMFM-88) D area (standing) and E area(walking,running and jumping).Results At baseline,there were not significantly differences between the two groups in terms of MAS,PROM and GMFM-88 (P ＞ 0.05).At 2 weeks,1 month,3 months and 6 months after the treatment,the injection group improved significantly with regard to all the parameters when compared to the baseline (P ＜ 0.05).The control group also improved with all the parameters at 1,3 and 6 months after the treatment (P ＜ 0.05).It was also shown that the injection group improved to a significantly greater extent than the control group at all the time points after treatment with regard to all the assessment parameters (P ＜ 0.05).Conclusion Ultrasound-guided BTX-A injection combined with rehabilitation therapy can quickly relieve the plantarflexion deformity in CP children.It is worthy of clinical application and promotion.