50例脑性瘫痪下肢痉挛患儿A型肉毒毒素注射治疗疗效观察

Clinical value of electrical stimulation-guided botulinum toxin type A injection for lower limb spasticity in cerebral palsy children

目的探讨电刺激引导下A型肉毒毒素注射脑性瘫痪儿童下肢痉挛肌的疗效。方法50例脑性瘫痪下肢痉挛患儿，采用电刺激定位下多位点注射治疗。注射前给予摄相，测量关节角度，评定肌张力，分别于注射后3、7d和1、2、3个月进行撮相，关节角度测量，肌张力评定。注射后72h开始进行痉挛肌牵拉及功能训练，1周配戴矫形鞋，并强化康复训练。结果摄相显示下肢功能改善起效时间为注射后3d，高峰1～2周，疗效维持时间3个月。下肢关节角度改善为注射后3d开始显著增大，差异有统计学意义（P〈0．001），1～2周达高峰，差异有统计学意义（P〈0．001），至3个月变小，但未回复到注射前。痉挛肌改良Ashworth分级与关节活动度变化规律一致。粗大运动评分1个月后显著改善，并在随后观察中持续性改善。结论A型肉毒毒素注射治疗后配合矫形器及康复训练，能有效改善脑性瘫痪后下肢痉挛患儿的运动功能。

Objective To evaluate the clinical value of electrical stimulation-guided botulinum toxin type A injection for lower limb spasticity in cerebral palsy children. Methods After signing the informed consent, 50 cerebral palsy children with lower limb spasticity were treated with botulinum toxin type A （BTX-A） injection guided by electric stimulation. Demographic data,including age,gender,number of the spastic lower limbs,aftected side （left or right） were recorded. Clinical assessments including the range of passive movement and muscular tension were determined before treatment and at 3d, 7d, 1 month,2 months,and 3 months after treatment. Physiotherapy was applied to children at 72h after injection,and ankle-foot orthosis were applied to children at 7d after injection. Results Lower limb function started to improve after 3d of treatment, peaked at 1- 2 weeks, and lasted for 3 months. Lower limb joint angles started to improve after 3d of treatment （P（0. 001） and peaked at 1-2 weeks （P（0. 001）. The effect decreased 3 months after injection, but the children were still significantly improved compared with the parameters measured pre-injection. The changes showed on the Modified Ashworth Scale of the spastic muscle were consistent with the improvement seen with the other measures of range of motion. The Gross Motor Function Measure increased significantly 1 month post-injection and this change was observed to persist for a few months. Conclusion BTX-A injection guided by electrical stimulation in combination with physiotherapy can reduce spasticity and improve functional performance in standing, walking, walking pattern and velocity on spasticity in ankle plantar flexors of ambulant children with cerebral palsy.