康复训练及A型肉毒毒素注射治疗脑卒中下肢肌痉挛

Rehabilitation Training Combined with Botulinum Toxin A for Patients with Lower Limb Spasticity after Stroke

目的:探讨康复训练结合A型肉毒毒素(BTX-A)注射对脑卒中后下肢肌痉挛患者肌张力、运动功能及步行能力的影响。方法:选择32例下肢伸肌痉挛,改良Ashworth痉挛量表(MAS)评定2～3级的脑卒中患者,随机分为综合组及对照组各16例。2组患者均对下肢痉挛肌群进行分点注射BTX-A。综合组在注射24 h后结合康复训练,包括神经发育技术、物理疗法及运动疗法等。2组治疗前后采用MAS评定下肢肌张力及Fugl-Meyer运动量表(FMA)评定下肢运动功能;并进行步速和步长测定。结果:BTX-A注射后1、6及12周时,2组患者MAS评分明显下降,FMA评分明显上升,步速和步长明显提高(均P<0.05)。2组间比较,综合组表现更明显(P<0.05)。结论:康复训练结合BTX-A注射可以显著降低脑卒中痉挛肢体的肌张力,提高运动功能和步行能力。

Objective： To investigate the effect of rehabilitation training combined with botulinum toxin A for patients with lower limb spasticity,movement dysfunction and disability to walk after stroke.Methods： Thirty-two patients with stroke were randomly divided into experimental group and control group,whose lower limb spasticity evaluated by Modified Ashworth Scale（MAS） was Ashworth level II-level III.The patients in experimental group received rehabilitation training combined with botulinum toxin A,and those in control group received injection of botulinum toxin A only.The patients in both two groups were separately subjected to the rehabilitation evaluation before,and 1st week,6th week and 12th week after the injection of botulinum toxin A.The evaluation of MAS,Fugl-Meyer（FMA） movement function assessment and gait analysis were done.Results： The scores of MAS in experimental group were lower,and the scores of FMA gait analysis were higher than in control group（P0.05）.Conclusion： Rehabilitation training combined with botulinum toxin A can reduce the extent of spasticity,and improve the ability to movement function of patients with stroke.