CAJ | 학술논문

目的观察踝足矫形器(A FO)联合A型肉毒毒素(BTX-A)肌肉注射治疗痉挛型脑瘫患儿尖足的疗效.方法痉挛型脑瘫患儿尖足畸形50例,采用随机数字表法将其分为对照组和观察组,每组25例,对照组患儿采用BTX-A肌肉注射与运动康复训练,观察组在对照组基础上加用AFO训练,与其运动康复训练同步.分别于治疗前、治疗后1、3和6个月,使用量角器测量踝关节的被动背屈角(APROM),改良Ashworth量表的评分(MAS)以及粗大运动功能量表(GMFM-88)的D区(站立)和E区(走跑跳)评分.结果治疗前,观察组APROM、MAS和GMFM(D、E)分别为(109.25±12.38)°、(3.12±0.56)分和(55.32±11.23)分,与对照组[(107.11±13.44)°、(3.05±0.66)分和(56.21±10.81)分]比较,差异均无统计学意义(P＞0.05).2组患儿的APROM、MAS和GMFM评分在治疗后1、3和6个月时与组内与治疗前比较,差异均有统计学意义(P＜0.05);治疗后,观察组APROM、MAS和GMFM评分分别与对照组治疗比较,差异亦均有统计学意义(P＜0.05).2组治疗后各时间点之间的评估指标比较,观察组差异均有统计学意义;对照组治疗后1个月与治疗后3个月比较,差异有统计学意义(P＜0.05),治疗后3个月和治疗后6个月比较,差异无统计学意义(P＞0.05).结论 AFO联合BTX-A疗法能进一步缓解痉挛型脑瘫患儿的下肢痉挛程度,减轻尖足异常姿势,维持时间更持久.
목적 관찰과족교형기(A FO)연합A형육독독소(BTX-A)기육주사치료경련형뇌탄환인첨족적료효.방법 경련형뇌탄환인첨족기형50례,채용수궤수자표법장기분위대조조화관찰조,매조25례,대조조환인채용BTX-A기육주사여운동강복훈련,관찰조재대조조기출상가용AFO훈련,여기운동강복훈련동보.분별우치료전、치료후1、3화6개월,사용량각기측량과관절적피동배굴각(APROM),개량Ashworth량표적평분(MAS)이급조대운동공능량표(GMFM-88)적D구(참립)화E구(주포도)평분.결과 치료전,관찰조APROM、MAS화GMFM(D、E)분별위(109.25±12.38)°、(3.12±0.56)분화(55.32±11.23)분,여대조조[(107.11±13.44)°、(3.05±0.66)분화(56.21±10.81)분]비교,차이균무통계학의의(P＞0.05).2조환인적APROM、MAS화GMFM평분재치료후1、3화6개월시여조내여치료전비교,차이균유통계학의의(P＜0.05);치료후,관찰조APROM、MAS화GMFM평분분별여대조조치료비교,차이역균유통계학의의(P＜0.05).2조치료후각시간점지간적평고지표비교,관찰조차이균유통계학의의;대조조치료후1개월여치료후3개월비교,차이유통계학의의(P＜0.05),치료후3개월화치료후6개월비교,차이무통계학의의(P＞0.05).결론 AFO연합BTX-A요법능진일보완해경련형뇌탄환인적하지경련정도,감경첨족이상자세,유지시간경지구.
Objective To observe the clinical efficacy of ankle-foot orthosis (AFO) combined with botulinum toxin type A (BTX-A) injection in treating tip foot deformity in children with cerebral palsy (CP).Methods Fifty CP children with tip foot deformity were selected and randomly divided into a control group and an observation group according to a random number table.Both groups were given BTX-A injection, and the observation group was additionally treated with AFO.All children were assessed before, 1 month, 3 months and 6 months after the treatment using the modified Ashworth scale (MAS), passive ankle range of movement (APROM0 and gross motor function measurement scale-88 (GMFM-88) D area (standing) and E area (walking, running and jumping).Results Before the treatment, there were not significant differences between the two groups in all measurements (P ＞ 0.05).At 1 month, 3 months and 6 months after the treatment, significant differences were observed in all values for both groups compared to before the treatment (P ＜ 0.05).There was significant difference between two groups at all the same time points after treatment with regard to all the assessment parameters (P ＜ 0.05).In the control group, significant differences were found in all measurements after 1 and 3 months' treatment, but not found after 3 and 6 months' treatment.Conclusion AFO combined with BTX-A) injection can further relieve lower limb spasticity and reduce tip foot abnormal posture with longer duration.