酚与肉毒毒素运动点阻滞对脑瘫患儿痉挛的影响

The effect of motor point blocking on spasticity in children with cerebral palsy

目的比较A型肉毒毒素（BTX-A）阻滞术和酚阻滞术缓解脑性瘫痪患儿痉挛的优劣。方法420例痉挛型脑瘫患儿（男271例，女149例），年龄1～22岁，平均6．87岁。依据患儿的就诊时间分为对照组和实验组，均行痉挛的小腿三头肌（腓肠肌、比目鱼肌）神经阻滞术。1997年7月至2000年1月收治的患儿设为对照组，共45例，应用5％的酚溶液行神经阻滞术治疗，用量为0．5～4．6ml，平均2．2ml；2000年1月至2010年2月收治的患儿设为实验组，375例，应用BTX．A行神经阻滞术治疗，用量为55～350IU，平均130．5Iu。在阻滞术后，2组患儿均进行系统的功能康复训练。于神经阻滞术前、后分别采用医师评定量表（PRS）评分进行运动功能评价，采用修改的Ashworth评分法对2组脑瘫患儿的痉挛程度进行评定。并对这2种药物行神经阻滞术的疗效、疗效持续时间及药物的不良反应发生情况进行对比观察。结果术前2组脑瘫患儿的运动障碍功能程度及痉挛程度组间差异无统计学意义（P〉0．05），具有可比性。术后2组患儿的痉挛程度均下降，组内差异有统计学意义（P〈0．01）。实验组BTX-A阻滞术的有效率为98．4％，对照组酚阻滞术的有效率为95．6％，2组患儿的疗效差异无统计学意义（P〉0．05）；实验组的疗效持续时间为（24．9±5．76）周，对照组的疗效持续时间平均为（69．2±13．76）周，明显长于实验组患儿（P〈0．01）；实验组的不良反应发生率为5．33％，对照组患儿的不良反应发生率为15．56％，明显高于实验组患儿（P〈0．01）。结论BTX-A神经阻滞术更安全、更可靠，具有更广阔的发展前景。

Objective To compare the advantages and disadvantages of botulinum toxin A （BTX-A） and phenol block in the treatment of spasticity in children with cerebral palsy. Methods Four hundred and twenty children with spastic cerebral palsy were divided into an experimental group （375 cases） and a control group （45 cases）. The children were aged from 1 to 22 years （average age 6 years）. The children in the experimental group were treated with BTX-A block at a dosage of 55 to 350 IU （average 130.5 IU）. The children in the control group were treated with a 5% phenol solution block at a dosage of 0.5 to 4.6 ml （ average 2.2 ml）. Children of both groups ~erc given systematic functional rehabilitation training. All the children were evaluated with a physician rating scale（PRS） and the modified Ashworth scale （MAS） before and after the blocking. Effectiveness rates, effectivenes durations and side effects rates were calculated. Results Before treatment there was no significant difference in terms of motor disorder or spasticity between the 2 groups. After treatment, spasticity had been significantly reduced in both groups. The effectiveness rate was 98.4% in the experimental group and 95.6% in the control group, a difference which was not significant. The average effectiveness duration was （24.9 ± 5.76） weeks in the experimental group and （69.2 ± 13.76） weeks in the control group, significantly longer. The side effects rate was 5.33% in the experimental group and 15.56% in the control group, also a significant difference. Conclusion BTX-A could be more widely used because of its safety and credibility.