CAJ | 학술논문

目的：观察电刺激定位在肉毒素注射中的临床价值。方法：脑卒中后肌痉挛患者45例，按痉挛部位分组，肱二头肌组分为电刺激定位组18例（A1组）采用电刺激定位法，徒手定位组17例（A2组）采用徒手定位法，下肢组分为电刺激定位组20例（B1组）及徒手定位组20例（B2组）。注射前后采用改良Ashworth评级（MAS）及表面肌电积分值（IEMG）评价肌张力，测量被动关节活动度（PROM）评定肘、踝跖屈曲活动度；运动功能评定量表（FMA）、10m步速评估下肢运动功能。结果：治疗后2、4、8及12周时，A1、A2组MAS及IEMG评分均较治疗前呈逐渐下降趋势（P＜0．05），且A1组更低于A2组（P＜0．05）；治疗后，A1、A2组肘关节屈曲PROM及上肢FMA评分均较治疗前呈逐渐升高趋势（P＜0．05），且A1组肘关节屈曲PROM在治疗后4、8及12周时较A2组提高更显著（P＜0．05），A1组上肢FMA在治疗后8及12周时较A2组提高更显著（P＜0．05）。治疗后2、4、8及12周时，B1、B2组MAS、IEMG评分及10m步行时间均较治疗前呈逐渐下降趋势（P＜0．05），B1、B2组下肢踝关节跖屈PROM及下肢FMA评分均较治疗前呈逐渐升高趋势（P＜0．05）且B1组下肢踝关节跖屈PROM在治疗后2周及下肢FMA在治疗后12周较B2组提高更显著（P＜0．05），余各项评分及时间点2组间比较差异无统计学意义。结论：肱二头肌采用电刺激定位肉毒素注射临床治疗肌痉挛的临床效果优于徒手定位；比目鱼肌、腓肠肌及胫后肌采用电刺激定位肉毒素注射临床治疗肌痉挛的临床效果与徒手定位比较，差异无统计学意义。
목적：관찰전자격정위재육독소주사중적림상개치。방법：뇌졸중후기경련환자45례，안경련부위분조，굉이두기조분위전자격정위조18례（A1조）채용전자격정위법，도수정위조17례（A2조）채용도수정위법，하지조분위전자격정위조20례（B1조）급도수정위조20례（B2조）。주사전후채용개량Ashworth평급（MAS）급표면기전적분치（IEMG）평개기장력，측량피동관절활동도（PROM）평정주、과척굴곡활동도；운동공능평정량표（FMA）、10m보속평고하지운동공능。결과：치료후2、4、8급12주시，A1、A2조MAS급IEMG평분균교치료전정축점하강추세（P＜0．05），차A1조경저우A2조（P＜0．05）；치료후，A1、A2조주관절굴곡PROM급상지FMA평분균교치료전정축점승고추세（P＜0．05），차A1조주관절굴곡PROM재치료후4、8급12주시교A2조제고경현저（P＜0．05），A1조상지FMA재치료후8급12주시교A2조제고경현저（P＜0．05）。치료후2、4、8급12주시，B1、B2조MAS、IEMG평분급10m보행시간균교치료전정축점하강추세（P＜0．05），B1、B2조하지과관절척굴PROM급하지FMA평분균교치료전정축점승고추세（P＜0．05）차B1조하지과관절척굴PROM재치료후2주급하지FMA재치료후12주교B2조제고경현저（P＜0．05），여각항평분급시간점2조간비교차이무통계학의의。결론：굉이두기채용전자격정위육독소주사림상치료기경련적림상효과우우도수정위；비목어기、비장기급경후기채용전자격정위육독소주사림상치료기경련적림상효과여도수정위비교，차이무통계학의의。
Objective:To observe the clinical value of electrical stimulation guidance for botulinum toxin injection .Methods:Forty‐five stroke patients with spasm were selected .These patients were divided into the biceps brachii group and lower ex‐tremity groups according to the different spasm parts .The patients in the biceps brachii group were assigned into electrical stimulation subgroup(subgroup A1)(n=18) subject to electrical stimulation directing injection ,and manual palpation‐guided subgroup(subgroup A2)(n=17) to manual palpation‐guided location .The patients in the lower extremity group were as‐signed into electrical stimulation subgroup(group B1)(n=20) and manual palpation‐guided subgroup(group B2)(n=20) . Modified Ashworth Scale(MAS) ,Intergrated EMG(IEMG) ,Passive Range of Motion(PROM ) ,Fugl‐Meyer Motor Func‐tion Assessment(FMA) and speed of gait were applied before and after treatment .Results:In subgroups A1 and A2 ,the measurement indexes of MAS and IEMG showed a gradual decrease after treatment(P<0 .05) ,and the indexes in subgroup A1 were lower than in subgroup A2(P<0 .05) .In subgroups A1 and A2 ,the measurement indexes of PROM and FMA showed a gradual increase after treatment(P<0 .05) ,and the PROM at the 4th ,8th and 12th week ,and the FMA at the 8th and 12th week after treatment in subgroup A1 were increased significantly as compared with subgroup A2(P<0 .05) .In subgroups B1 and B2 ,the measurement indexes of MAS ,IEMG and speed of gait showed a gradual decrease after treatment (P<0 .05) ,and PROM and FMA showed a gradual increase after treatment(P<0 .05) .As compared with subgroup B2 , the PROM at the 2nd ,and the FMA at the 12th week in subgroup B1 were increased significantly(P<0 .05) .There was no statistically significant difference in the variations of measurement indexes during follow‐up periods between two groups . Conclusions:In biceps brachii ,electrical stimulation location guidance for botulinum toxin injection got more satisfactory clini‐cal results than the manual palpation‐guided in treatment of muscle spasticity ;In gastrocnemius ,soleus and posterior tibial muscle ,the clinical effects of electrical stimulation positioning botox injections in the treatment of muscle spasticity showed no statistically significant difference in comparison to manual palpation‐guided location.