中国康复
中國康複
중국강복
CHINESE JOURNAL OF REHABILITATION
2015年
4期
243-246
,共4页
鲍晓%王鸣鸿%刘惠宇%谭杰文%黄东锋
鮑曉%王鳴鴻%劉惠宇%譚傑文%黃東鋒
포효%왕명홍%류혜우%담걸문%황동봉
A 型肉毒毒素%针灸%肌痉挛%fMRI
A 型肉毒毒素%針灸%肌痙攣%fMRI
A 형육독독소%침구%기경련%fMRI
botulinum toxin A%acupuncture%myospasm%fMRI
目的：：观察肉毒毒素注射结合针灸疗法对脑梗死上肢局部肌痉挛患者疗效以及治疗前后上肢运动的 fM-RI 变化,并分析其机制。方法：脑梗死后上肢局部肌痉挛患者60例,随机分为3组各20例,A 组采用 A 型肉毒毒素注射配合针灸以及康复训练,B 组采用肉毒毒素注射及常规康复训练,C 组则仅予以常规康复训练。治疗前后采用改良 Ashworth 评分、Wolf 运动功能评定、Fugl-Meyer 上肢功能评分,并结合超声观察引起上肢屈肌痉挛肌肉的长度、厚度的变化,以及上肢运动的 fMRI 变化。结果：治疗3周后,3组患者 Fugl-Meyer 上肢功能评分及 Wolf 运动功能评定评分均较治疗前明显提高(P <0.05),且 A 组更高于 B、C 组(P <0.05)、B 组更高于 C 组(P <0.05)；3组改良 Ashworth 分级和 Wolf 评定时间评分均较治疗前明显下降(P <0.05),且 A 组更低于 B、C 组(P <0.05)、B组更低于 C 组(P <0.05)。A、B 组患者在静息时肱二头肌长度均较治疗前及 C 组明显增加(P <0.05),并接近正常人的肌长度；C 组治疗前后肱二头肌长度比较差异无统计学意义；3组患者在静息时的肌纤维厚度、最大等长收缩的肌纤维长度和厚度治疗前后比较差异无统计学意义。A、B 组患者肱二头肌屈伸肌力均较治疗前及 C 组明显增加(P <0.05),C 组治疗前后比较差异无统计学意义。A、B 组患者 SM1区激活面积及激活强度均较治疗前增大(P <0.05),2组 SMA 区和小脑激活区域治疗前后比较差异无统计学意义。结论：A 型肉毒毒素联合针灸疗法可以较好的缓解脑梗死后上肢局部肌痉挛,增加上肢活动的灵活性,以及患者的日常生活功能。
目的：：觀察肉毒毒素註射結閤針灸療法對腦梗死上肢跼部肌痙攣患者療效以及治療前後上肢運動的 fM-RI 變化,併分析其機製。方法：腦梗死後上肢跼部肌痙攣患者60例,隨機分為3組各20例,A 組採用 A 型肉毒毒素註射配閤針灸以及康複訓練,B 組採用肉毒毒素註射及常規康複訓練,C 組則僅予以常規康複訓練。治療前後採用改良 Ashworth 評分、Wolf 運動功能評定、Fugl-Meyer 上肢功能評分,併結閤超聲觀察引起上肢屈肌痙攣肌肉的長度、厚度的變化,以及上肢運動的 fMRI 變化。結果：治療3週後,3組患者 Fugl-Meyer 上肢功能評分及 Wolf 運動功能評定評分均較治療前明顯提高(P <0.05),且 A 組更高于 B、C 組(P <0.05)、B 組更高于 C 組(P <0.05)；3組改良 Ashworth 分級和 Wolf 評定時間評分均較治療前明顯下降(P <0.05),且 A 組更低于 B、C 組(P <0.05)、B組更低于 C 組(P <0.05)。A、B 組患者在靜息時肱二頭肌長度均較治療前及 C 組明顯增加(P <0.05),併接近正常人的肌長度；C 組治療前後肱二頭肌長度比較差異無統計學意義；3組患者在靜息時的肌纖維厚度、最大等長收縮的肌纖維長度和厚度治療前後比較差異無統計學意義。A、B 組患者肱二頭肌屈伸肌力均較治療前及 C 組明顯增加(P <0.05),C 組治療前後比較差異無統計學意義。A、B 組患者 SM1區激活麵積及激活彊度均較治療前增大(P <0.05),2組 SMA 區和小腦激活區域治療前後比較差異無統計學意義。結論：A 型肉毒毒素聯閤針灸療法可以較好的緩解腦梗死後上肢跼部肌痙攣,增加上肢活動的靈活性,以及患者的日常生活功能。
목적：：관찰육독독소주사결합침구요법대뇌경사상지국부기경련환자료효이급치료전후상지운동적 fM-RI 변화,병분석기궤제。방법：뇌경사후상지국부기경련환자60례,수궤분위3조각20례,A 조채용 A 형육독독소주사배합침구이급강복훈련,B 조채용육독독소주사급상규강복훈련,C 조칙부여이상규강복훈련。치료전후채용개량 Ashworth 평분、Wolf 운동공능평정、Fugl-Meyer 상지공능평분,병결합초성관찰인기상지굴기경련기육적장도、후도적변화,이급상지운동적 fMRI 변화。결과：치료3주후,3조환자 Fugl-Meyer 상지공능평분급 Wolf 운동공능평정평분균교치료전명현제고(P <0.05),차 A 조경고우 B、C 조(P <0.05)、B 조경고우 C 조(P <0.05)；3조개량 Ashworth 분급화 Wolf 평정시간평분균교치료전명현하강(P <0.05),차 A 조경저우 B、C 조(P <0.05)、B조경저우 C 조(P <0.05)。A、B 조환자재정식시굉이두기장도균교치료전급 C 조명현증가(P <0.05),병접근정상인적기장도；C 조치료전후굉이두기장도비교차이무통계학의의；3조환자재정식시적기섬유후도、최대등장수축적기섬유장도화후도치료전후비교차이무통계학의의。A、B 조환자굉이두기굴신기력균교치료전급 C 조명현증가(P <0.05),C 조치료전후비교차이무통계학의의。A、B 조환자 SM1구격활면적급격활강도균교치료전증대(P <0.05),2조 SMA 구화소뇌격활구역치료전후비교차이무통계학의의。결론：A 형육독독소연합침구요법가이교호적완해뇌경사후상지국부기경련,증가상지활동적령활성,이급환자적일상생활공능。
Objective:To study the effect of botulinum toxin type A combined with acupuncture for muscle spasm after stroke and fMRI.Methods:Sixty patients with muscle spasm were randomly divided into three groups.Group A was given botulinum toxin type A combined with acupuncture,group B botulinum toxin type A alone,and group C conventional therapy.Fugl-Meyer,Wolf motor function test (WMFT),modified ashworth scale,length and thickness of musculus biceps brachii through ultrasound,and changes of the fMRI before and after the treatment were recorded respectively.Results:Scores of Fugl-Meyer,WMFT and modified ashworth scale in three groups af-ter treatment were significantly increased as compared with those at 3rd week before treatment (P < 0.05 ).The scores of Fugl-Meyer,WMFT and modified ashworth scale in group A were significantly higher than those of the re-maining two groups after treatment (P <0.05),and those in group B were significantly higher than in group C after treatment (P <0.05 ).Length and thickness of musculus biceps brachii in groups A and B were significantly in-creased before treatment as compared with those after treatment (P <0.05).Thickness of musculus biceps brachii in quiescent condition and maximal isometric contraction showed no significant difference after treatment among the Objective:To study the effect of botulinum toxin type A combined with acupuncture for muscle spasm after stroke and fMRI.Methods:Sixty patients with muscle spasm were randomly divided into three groups.Group A was given botulinum toxin type A combined with acupuncture,group B botulinum toxin type A alone,and group C conventional therapy.Fugl-Meyer,Wolf motor function test (WMFT),modified ashworth scale,length and thickness of musculus biceps brachii through ultrasound,and changes of the fMRI before and after the treatment were recorded respectively.Results:Scores of Fugl-Meyer,WMFT and modified ashworth scale in three groups af-ter treatment were significantly increased as compared with those at 3rd week before treatment (P < 0.05 ).The scores of Fugl-Meyer,WMFT and modified ashworth scale in group A were significantly higher than those of the re-maining two groups after treatment (P <0.05),and those in group B were significantly higher than in group C after treatment (P <0.05 ).Length and thickness of musculus biceps brachii in groups A and B were significantly in-creased before treatment as compared with those after treatment (P <0.05).Thickness of musculus biceps brachii in quiescent condition and maximal isometric contraction showed no significant difference after treatment among the three groups (P >0.05).Flexor muscle strength of the biceps brachii in groups A and B after treatment were significantly increased as compared with those in group C and before treatment (P <0.05).SM1 activation are-as and activation intensity were increased after treat-ment in groups A and B as compared with those before treatment,and there was no significant difference in SMA and cerebellum in groups A and B before and after treat-ment.Conclusion:The treatment of botulinum toxin type A combined with acupuncture can alleviate the muscle spasm of the upper limbs,and improve the motor function of the upper limbs and the activities of daily living after stroke.
