A型肉毒毒素治疗卒中患者痉挛性足下垂和足内翻的研究

Research on botulinum toxin type A in the treatment of spastic foot drop and inversion after stroke

目的探讨A型肉毒毒素治疗卒中后足下垂及足内翻患者，随机患者痉挛性足下垂及足内翻的效果及对步行功能的改善。方法35例卒中后痉挛性分为BTX2A注射结合物理治疗组（17例）和单纯物理治疗组（18例）。治疗组应用下肢肌肉局部注射国产A型肉毒毒素治疗，每个患者每次选择3～5块肌肉，每块肌肉总的注射剂量为50～100IU。对照组仅接受康复治疗。所有患者在注射前，注射后2周、1个月、3个月改良Ashworth量表（MAS）评定肌张力变化，按粗大运动功能量表（GMFM）中的D和E两项及步行速度评价步行能力。结果MAS评分治疗后2周、1个月、3个月组间差异均有统计学意义（P〈0．05）。GMFM评分治疗后1、3个月组间差异均有统计学意义（P〈0．05）。步行速度治疗后1、3个月组间差异均有统计学意义（P〈0．05）。结论研究发现下肢肌肉局部注射A型肉毒毒素结合康复治疗可以更好减轻脑卒中患者的肌张力，改善患者的痉挛步态。

Objective To determine the effect of botulinum toxin A （BTX2A） for spastic foot drop and inversion and improvement of walking ability after stroke. Methods 35 eases with stroke were randomly assigned into 2 groups,BTX2A group （n=17） treated with BTX2A injection and physiotherapyalone group （n = 18） . Patients in BTX2A group received local intramuscular injection. Each patient chose 3 to 5 pieces of muscles every time. The injection dose was between 50-100IU for a muscle. The physiotherapyalone group received only rehabilitation therapy. Patients were assessed at entry and at 2 weeks, 1 and 3 months after treatment. The muscle tone of all patients was assessed by the modified Ashworth scale. The ability of walking was assessed by D and E dimensions of the gross motor function measure （GMFM） and walking velocity （WV） . Results The differences of PROM and MAS between the 2 groups at 2 weeks, 1 month and 3 months examination were also statistically significant （P〈0. 05） . The difference in GMFM between the 2 groups was statistically significant （P〈0.05）1 month and 3 months after treatment. The difference of WV between the 2 groups was statistically significant （P〈0.05） 1 month and 3 months after treatment. Conclusion The results of the present study indicate that botulinum toxin type A injection combined rehabilition therapy can result a long-lasting decrease in spasticity and an improvement walking ability after stroke.