CAJ | 학술논문

目的观察超声定位下注射A型肉毒毒素(BTX-A)联合矫形器康复训练治疗脑瘫患儿下肢痉挛的疗效.方法采用随机数字表法将54例痉挛型脑瘫患儿分为观察组及对照组.对照组患儿给予常规康复训练,观察组患儿则在常规康复训练基础上辅以超声引导下BTX-A注射,并于BTX-A注射24 h后指导脑瘫患儿穿戴膝踝足矫形器进行康复训练.于治疗前、治疗6周后分别采用改良Ashworth量表(MAS)、粗大运动功能量表(GMFM)对2组患儿下肢功能进行评定,同时检测、比较2组患儿大腿内收肌角、腘窝角及踝关节活动范围情况.结果观察组及对照组患儿分别经6周治疗后,发现其MAS评分[分别为(1.26±0.63)分和(2.56土0.71)分]均较治疗前有所降低,GMFM分值[分别为(69.21±11.67)分和(62.61±10.74)分]及大腿内收肌角[分别为(100.9±21.1)°和(89.3±23.2)°]、腘窝角[分别为(126.1±10)°和(117.4±13.4)°]、踝关节活动范围[分别为(80.1±9.1)°和(70.4±9.2)°]均较治疗前有所增加,并且上述指标均以观察组患儿的改善幅度较显著,与对照组间差异均具有统计学意义(P＜0.05).结论超声引导下注射BTX-A治疗脑瘫患儿下肢痉挛具有定位准确、疗效确切、不良反应少等优点,可有效缓解脑瘫儿童下肢痉挛,如注射BTX-A后穿戴膝踝足矫形器进行康复训练,则能进一步缓解痉挛性脑瘫患儿下肢痉挛并提高其肢体运动功能.
목적 관찰초성정위하주사A형육독독소(BTX-A)연합교형기강복훈련치료뇌탄환인하지경련적료효.방법 채용수궤수자표법장54례경련형뇌탄환인분위관찰조급대조조.대조조환인급여상규강복훈련,관찰조환인칙재상규강복훈련기출상보이초성인도하BTX-A주사,병우BTX-A주사24 h후지도뇌탄환인천대슬과족교형기진행강복훈련.우치료전、치료6주후분별채용개량Ashworth량표(MAS)、조대운동공능량표(GMFM)대2조환인하지공능진행평정,동시검측、비교2조환인대퇴내수기각、객와각급과관절활동범위정황.결과 관찰조급대조조환인분별경6주치료후,발현기MAS평분[분별위(1.26±0.63)분화(2.56토0.71)분]균교치료전유소강저,GMFM분치[분별위(69.21±11.67)분화(62.61±10.74)분]급대퇴내수기각[분별위(100.9±21.1)°화(89.3±23.2)°]、객와각[분별위(126.1±10)°화(117.4±13.4)°]、과관절활동범위[분별위(80.1±9.1)°화(70.4±9.2)°]균교치료전유소증가,병차상술지표균이관찰조환인적개선폭도교현저,여대조조간차이균구유통계학의의(P＜0.05).결론 초성인도하주사BTX-A치료뇌탄환인하지경련구유정위준학、료효학절、불량반응소등우점,가유효완해뇌탄인동하지경련,여주사BTX-A후천대슬과족교형기진행강복훈련,칙능진일보완해경련성뇌탄환인하지경련병제고기지체운동공능.
Objective To observe the effect of ultrasound-guided injection of botulinum toxin type A (BTX-A) combined with orthosis training for the treatment of lower limb spasticity for children with cerebral palsy.Methods Fifty-four patients with spastic cerebral palsy were randomly divided into an observation group and a control group using a random number table.Patients in the control group were given conventional rehabilitation training,while those in the observation group were additionally given ultrasound-guided BTX-A injection,followed by daily knee-ankle-foot orthosis rehabilitation training 24 h after the injection.Before and 6 weeks after treatment the lower limb function of the 2 groups was evaluated using the modified Ashworth scale (MAS) and the gross motor function measure (GMFM).Adductor angles,popliteal angles and motor ranges of the ankle joint were also measured and compared.Results After 6 weeks the average MAS scores were lower than before treatment in both observation[(1.26±0.63) vs (3.07±0.68)] and control group [(2.56±0.71) vs (2.89±0.64).And in both groups the average GMFM scores,adductor angles and popliteal angles,as well as range of motion of the ankle were all much better than before treatment.The observation group,however,improved significantly more than the control group(P ＜ 0.05).Conclusion Ultrasound-guided injection of BTX-A can effectively alleviate spasticity of lower extremity for children with cerebral palsy with accurate positioning,obvious curative effect and less adverse reactions.Knee-ankle-foot orthosis rehabilitation training after the injection can further alleviate spasticity and improve the motor function of the limbs.