A型肉毒毒素治疗痉挛型脑性瘫痪合并膝反张疗效观察

Effects of botulinum toxin injection on genu recurvatum of children with cerebral palsy

目的观察A型肉毒毒素治疗痉挛型脑性瘫痪合并膝反张疗效。方法选择63例脑瘫患儿,随机分为2组:①BTX-A注射结合康复治疗组(BTX-A组,33例);②单纯康复治疗组(30例)。患儿入选后分别在治疗前,治疗后的2周、1、2、3、6个月进行以下评定:①改良Ashworth量表(MAS)②,PRS量表评定运动功能③膝关节最大伸直度。结果两组患儿改良阿氏肌张力评价量表(MAS)、PRS量表评定运动功能得分、膝关节最大伸直度治疗前无显著性差异(P>0.05),治疗后2周、1、2、3、6个月组内均有显著性差异(P均<0.05)。改良阿氏肌张力评价量表(MAS)、PRS量表评定运动功能得分组间均有显著性差异(P均<0.05)。膝关节最大伸直度治疗后1、2、3,6个月组间差异均有统计学意义。结论 BTX-A注射结合康复治疗较单纯康复治疗能更好地缓解脑瘫患儿下肢肌群痉挛及膝反张,提高患儿的运动能力。

Objective To evaluate the effect of botulinum toxin A （BTX-A） injection combined with physiotherapy, on the genu recurvatum in children with cerebral palsy（CP）. Methods Sixty-three children with CP were randomly divided into 2 groups：（1）BTX-A group（n=33） were treated with BTX-A injection and （2）physiotherapy alone group（n=30）. Clinical assessments including the range of modified Ashworth scale（MAS）, motion with physical rating scale（PRS） and genu recurvatum was determined before treatment and 2 weeks and 1,2,3 and 6 months after treatment. Results No statistically significant difference were found in age, gender, number of the spastic lower limbs, the affected side, as well as clinical assessments（MAS,PRS, genu recurvatum） before treatment between the 2 groups （P 〉0.05）. All children showed a reduction of spasticity（MAS,PRS,） after 2 weeks,1,2,3 and 6 months of treatment（P 〈0.05）. Conclusion BTX-A injection combined with physiotherapy is more effective than physiotherapy alone in terms of reducing spasticity and improving functional performance in standing, walking, walking pattern and genu recurvatum in children with CP.