A型肉毒毒素治疗痉挛型偏瘫脑性瘫痪儿童下肢运动障碍的临床研究

Clinical study of botulinum toxin A injection in the treatment of lower extremity in spastic hemiplegic cerebral palsied children

【目的】探讨A型肉毒毒素（BTX-A）注射结合康复治疗对痉挛型偏瘫脑性瘫痪儿童下肢运动障碍的临床作用。【方法】42例痉挛型偏瘫儿童（年龄39-86月）随机分为两组：BTX-A注射结合康复治疗组（BTX-A组,22例）及单纯康复治疗组（对照组,20例）。于BTX-A注射前及注射后2周、2个月,同时对两组患儿评定综合痉挛量表（CSS）、粗大运动功能88项量表（GMFM）中的G、E两能区及步态参数（健侧及患侧步长、步速）。所有患儿共接受为期3个月的康复治疗。【结果】BTX-A注射前两组CSS、GMFM（G、E两能区）评分及步态参数（健侧步长、患侧步长及步速）值比较差异均无显著性（P〉0.05）。BTX-A组注射治疗后2周、2个月时CSS评分与注射前及对照组相应时间比较差异有显著性（P〈0.01或〈0.05）,对照组与BTX-A组相应的2个月时CSS评分与其基线评分比较差异有显著性（P〈0.05）;BTX-A组注射后2个月GMFM评分、健侧步长、步速较治疗前及对照组比较差异有显著性（P〈0.05）,对照组GMFM评分及步态参数治疗前后比较差异无显著性（P〉0.05）。【结论】BTX-A注射结合康复治疗可快速有效地缓解偏瘫儿童的患侧下肢痉挛,并改善步态,提高运动能力。

[Objective] To investigate the clinical effects of Botulinum toxin A injection in the treatment of lower extremity in spastic hemiplegic cerebral palsied children. [Methods] 42 ambulant CP children （39486 months old） with spastic hemiplegia were chosen. They were randomly divided into 2 groups. BTX-A group （n= 22） received BTX-A injection and RT,the injection sites were gastrocnemius and adductors. Control group（n=20） treated with RT alone. The composite spasticity scale（CSS）, D and E dimensions of the gross motor function measure（GMFM-88）, gait evaluation （affected and nonaffected step length and walking velocity） were conducted for every child in the BTX-A group before BTX-A injection and at 2 weeks and 2 months after the injection. Also,these evaluation protocols were performed for every child in the control group at the same time. All children in 2 groups were treated with RT for 3 months. [Results] No statistically differents were found in CSS, GMFM （G, E） and gait index before treatment between the 2 groups （P〉 0. 05）. In BTX-A group,CSS showed significant decrease following injection when compared with the baseline findings and the control group （P〈0.01 or 〈0.05）. Significant differences were noted in BTX-A group in regard to GMFM,nonaffected step length and walking velicity（P〈0.05）. While no significant improvement was measured in respect to GMFM and gait evaluatoin （P〉 0.05）. [Conclusion] In spastic hemiplegic CP,Botulinum toxin A has a better effects on tone reduction and improvement on gait and skilled motor function.