脑卒中胸大肌痉挛患者肉毒毒素A治疗的疗效观察

Curative Effectiveness of Botulinum Toxin Type A for Pectoralis Major Muscle Spasm in Stroke Patients

目的:评价A型肉毒毒素(BTXA)治疗胸大肌痉挛的疗效。方法:脑卒中偏瘫并发胸大肌痉挛患者48例,随机分为BTXA组和对照组各24例,均按脑卒中常规康复方案治疗。BTXA组患者并行胸大肌BTXA注射(100 U及2 ml生理盐水)1次。治疗前和治疗后1个月行胸大肌肌张力Asworth评分,肩关节外展、外旋和前屈被动活动度测量,肩关节疼痛VAS评分,ADL评分。结果:治疗1个月后,2组胸大肌肌张力Asworth及VAS评分均有下降、肩关节被动活动度明显提高(P<0.05);2组间比较,BTXA组表现更明显(P<0.01)。ADL评分,2组治疗前后比较均差异无统计学意义。结论:BTXA注射可以减轻脑卒中胸大肌痉挛,改善肩关节活动度,缓解肩部疼痛。

Objective：To study the efficacy of botulinum toxin type A（BTXA） for the treatment of pectoralis major muscle spasm in stroke patients.Methods：Forty-eight patients were randomly divided into two groups：therapy group（24 cases） and control group（24 cases）.The patients in therapy group were given intramuscular injection of BTXA in the pectoralis major muscle and regularly physical therapy,and those in control group given regularly physical therapy only.Patients were assessed by using Visual Analogue Scale（VAS） for shoulder pain.Spasticity was measured by the modified Ashworth scale（MAS）.The passive range of motion（PROM） about shoulder was measured in 3 directions：inflexion,extension and external rotation.Activities of daily living（ADL） were also assessed.Measurements were made at baseline and one month after injection.Results：The improvement of score of MAS,VAS,and PROM in therapy group was obviously superior to that in control group（P0.05）,but there was no significant difference in the score of ADL in two groups before and after treatment.Conclusion：The injection of BTXA into pectoralis major muscle can relieve spasm of pectoralis major muscle,improve PROM of shoulder and relieve the shoulder pain.