A型肉毒毒素治疗儿童痉挛型脑性瘫痪的临床研究

A clinical research on local intramuscular injection of botulinum toxin A in the treatment of spastic cerebral palsy

目的 观察局部肌肉注射A型肉毒毒素 (BTX A)治疗痉挛型脑性瘫痪的疗效。方法 于 2 0 0 1年 5月至 2 0 0 3年 9月 ,用BTX A对 73例痉挛型脑性瘫痪的患儿进行局部肌肉注射 ,其中男性 5 2例 ,女性 2 1例。年龄1 6～ 15 (10 4± 2 5 )岁。以改良阿氏量表 (MAS)评定肌张力 ,以运动评价量表 (PRS)评定运动功能。分析治疗前、治疗后 4周及治疗后 3个月的肌张力、PRS评分改变情况 ,并随访治疗后BTX A产生疗效时间及副反应。结果 BTX A治疗前、治疗后 4周及治疗后 3个月肌张力、PRS评分有明显改善。治疗后 4周 ,PRS各项评分均有明显改善 (P <0 0 5 ) ,其中步态、关节弯曲度改善最明显 (P <0 0 0 1)。 4 8例 (6 6 % )患儿在治疗 2～ 3d出现疗效。副反应短暂、轻微 ,无全身副反应。结论 局部肌肉注射BTX A能够安全地治疗痉挛型脑性瘫痪 ,有效改善步态。

Objective To study the efficacy of botulinum toxin A(BTX A) intramuscular injection for the treatment of spastic cerebral palsy.Methods 73 patients (52 males,21 females) with spastic cerebral palsy received local intramuscular injection.The patients ranged in age from 1.6 to 15 years(average 10.4±2.5) years.The muscle tone was assessed with the Modified Ashworth Scale and range of motion with Physical Rating Scale.The patients were evaluated on therapeutic efficacy of local injection.To observe the muscle tone and PRS before therapy,four weeks and three months after therapy with BTX A.The data were analyzed with paired t test.We followed the patients on side effects and the time when the action took place.Results The statistical analysis of muscle tone and PRS had remarkable improvement four weeks and three months after therapy (P<0.001).Four weeks after injection,each index of PRS had been significantly changed (P<0 05),and the gait and crouch were most significantly improved(P<0 001).66% cases took effect in 2 to 3 days.The side effects were usually transient and mild,and no systemic adverse and allergic reactions took place.Conclusion Local intramuscular injection of BTX A is a relatively effective and safe treatment for spastic cerebral palsy.The therapy can significantly improve gait and walking ability.