A型肉毒毒素对脑性瘫痪患儿髂腰肌痉挛的疗效观察

Effect of Botulinum Toxin-A on Spastic Iliopsoas in Children with Cerebral Palsy

目的观察A型肉毒毒素(BTX-A)注射缓解脑瘫患儿髂腰肌痉挛的疗效。方法 2006年7月~2012年10月,37例存在髂腰肌痉挛的脑瘫患儿,年龄3~15岁,分为对照组(n=20)和试验组(n=17)。对照组患儿采用常规的物理治疗(PT)康复训练,试验组患儿在常规康复训练的基础上增加BTX-A注射治疗。共治疗8周。根据患儿体重和改良Ashworth量表(MAS)评分来确定BTX-A剂量,每次用量为在15~45 IU之间,平均(31.2±13.9)IU。结果两组患儿的年龄、体重、治疗前的MAS评分、粗大运动功能测试(GMFM)评分、髋关节屈曲角度均无有显著性差异(P>0.05)。两组患儿治疗后的MAS评分、髋关节屈曲角度较治疗前有所降低,GMFM评分有所提高。对照组的GMFM评分较治疗前升高(P<0.05),试验组的三项数据较治疗前均有显著性差异(P<0.05)。两组患儿治疗后三项数据均有显著性差异(P<0.05)。结论 BTX-A注射可以有效缓解脑瘫儿童髂腰肌痉挛。

Objective To observe the effect of Botulinum toxin-A (BTX-A) injection on spastic iliopsoas in the children with cerebral palsy. Methods July 2006 to August 2012, 37 cerebral palsy children with spastic iliopsoas were treated. The age ranged from 3 to 15 years. The control group (n=20) was treated by physical therapy. The experimental group (n=17) accepted BTX-A injection in addition. The dose of BTX-A block was identified with the weight of the child and the modified Ashworth Scale (MAS). The dose of injection ranged from 15 IU to 45 IU, average (31.2±13.9) IU. Results There was no significant difference between 2 groups in age, weight, MAS score, Gross Motor Function Measure (GMFM) score and extension angle of hip joints before treatment (P>0.05). In both groups, the MAS score decreased, GMFM score and extension angle of hip joints increased after 8 weeks. In the control group, the GMFM score improved significantly (P<0.05). In the experimental group, MAS score, GMFM score and extension angle of hip joints changed significantly after treatment. There was significant difference between 2 groups in MAS score, GMFM score and extension angle of hip joints after treatment (P<0.05). Conclu-sion The BTX-A injection can relieve iliopsoas spasticity on the children with cerebral palsy efficiently.