比较胫神经主干与腓肠肌运动分支乙醇阻滞术治疗脑卒中后痉挛性垂足的疗效和安全性

The Comparison of Efficacy and Safety of Neurolytic Block with Alcohol on Tibial Nerve Trunk vs Motor Branch of Gastrocnemius in the Treatment of Poststroke Spastic Drop Foot

目的:比较胫神经主干和腓肠肌运动分支乙醇阻滞术对脑卒中患者痉挛性垂足的疗效和安全性。方法:32例患者完成实验,随机分为主干组和分支组各16例,均应用5000e型电诊断仪在体表探测定位,主干组用无水乙醇行胫神经主干神经阻滞术;分支组行腓肠肌运动分支神经阻滞术,每一点的最大剂量<1ml。结果:2组患者均注射1～2次后痉挛性垂足的各项指标与治疗前比较均显著好转(P<0.05),2组间比较差异无显著性意义。随访6个月,主干组和分支组各有5例患者痉挛复发;并发症的发生率,主干组显著高于对照组(71.4%与12.5%,P<0.01)。结论:胫神经主干和腓肠肌运动分支乙醇神经阻滞治疗对脑卒中后痉挛性垂足均有疗效,经比较显示分支阻滞治疗安全性更高。

Objective：To compare the efficacy and safety of neurolytic block with alcohol on tibial nerve trunk vs motor branch of gastrocnemius in the treatment of poststroke spastic drop foot. Methods：Of 30 stroke patients with spastic drop foot, 14 cases were in trunk neurolytic group, and 16 cases in motor branch neurolytic group. By using BTL 5000e electrical stimulator, the injection point was detected, then 100% alcohol （not more than 1 mL） was injected in the trunk of tibial nerve or motor branch of gastrocnemius respectively. Results： The indicators for spasticity in both groups were significantly improved after treatment than before treatment （P〈0.05）, but no significant difference was found between the two groups. After follow up for 6 months, recurrence of the spsticity occurred in 5 cases each in both two groups. The incidence of complications was significantly higher in the trunk neurolytic group than in the motor branch neurolytic group （71.4% vs 12.5% ,P〈0.01）. Conclusion：Neurolytic block with alcohol on tibial nerve trunk or motor branch of gastrocnemius can effectively treat poststroke spastic drop foot, but more safe in the motor branch group than the trunk group.