肉毒毒素A对肌肉痉挛患者功能康复的作用

The effect of botulinum toxin type A on muscle spasticity

目的:探讨A型肉毒毒素(botulinumtoxintypeA,BTX-A)对上运动神经元损伤后肢体肌肉痉挛的治疗价值及其剂量影响。方法:选择48例上运动神经元损伤患者采用肉毒毒素A电刺激引导下局部肌肉注射治疗肌痉挛,其中把小腿三头肌、肱二头肌、屈指肌随机分成高低两个剂量组,观察剂量不同对疗效的影响,同时对所有患者制订注射后的目标,观察其达标情况。结果:肉毒毒素A注射后肌肉张力明显降低(P<0.05),但在小腿三头肌、肱二头肌及屈指肌群中均未发现明显的量效关系,各配对大小剂量组肌张力评分差异无显著性意义(P>0.05);患者功能显著改善,康复目标总达标率为70.4%,肉毒毒素对上肢的粗大运动及下肢的步行功能的改善效果明显,而对手的精细活动功能的恢复效果欠佳。结论:肉毒毒素A对缓解上运动神经元损伤后的肢体肌肉痉挛,提高其生活自理能力及运动功能疗效显著,肉毒毒素作用的量效关系尚有待确认。

Objective： To investigate the effect of botulinum toxin type A （BTX-A） on control of muscle spasticity and dose relationship in upper motor neuron syndrome. Method： Forty eight patients with spasticity were included in this study. BTX-A was injected under the guidance of electrical stimulation. Subgroup was designed by high and low dose of injection muscle tone before and after the block was assessed by modified Ashworth Scale. Functional goals were set up as an outcome measurement. Result： The muscle spasticity reduced markedly without significant demonstration of dose effect relationship. Optimal functional recovery was seen in 70.4% of the subjects, especially walking and gross movement of upper limbs. Improvement of fine motor function did not reach the significant level. Conclusion： BTX-A has significant effect on reduction of muscle spasticity, improvement of activity of daily living and motor function, but dose-effect relationship does not reach the significant level.