A型肉毒毒素注射配合康复功能训练对痉挛型偏瘫脑瘫患儿上肢运动功能疗效观察

Effect of Botulinum Toxin Type A Injection Combined with Rehabilitation Functional Training on Upper Extremity Motor Function in Children with Spastic Hemiplegic Cerebral Palsy

目的观察A型肉毒毒素(BTX-A)注射治疗配合康复功能训练对痉挛型偏瘫脑瘫患儿上肢功能障碍的疗效。方法 60例痉挛型偏瘫型脑瘫患儿均接受BTX-A注射治疗,治疗后进行强制性诱导运动训练、物理疗法、肌电生物反馈治疗、作业治疗及家庭训练。在治疗前与治疗3个月后,分别用改良Ashworth痉挛量表(MAS)评定患侧上肢肌张力、关节量角器法测量患侧腕关节主动背伸角度、Peabody运动发育量表(PDMS-II)进行患侧手精细运动商(FMQ)的评估、日常生活活动能力(ADL)量表评估ADL能力以比较观察疗效。结果治疗后患儿上述指标均较治疗前显著改善(P<0.001)。结论 BTX-A注射治疗配合康复功能训练能明显降低痉挛型偏瘫型脑瘫患儿的上肢肌张力,改善关节活动范围,明显提高上肢运动功能。

Objective To observe the effect of Botulinum toxin type A（BTX-A） injection combined with rehabilitation functional training on upper extremity motor function in children with spastic hemiplegic cerebral palsy（CP）.Methods 60 spastic hemiplegic CP children were treated with constraint-induced movement therapy（CIMT）,physical therapy,electromyographic biofeedback stimulation therapy,occupational therapy,family-based training and so on after injected with BTX-A.The muscle tension of the hemiplegic upper extremity accessed by Modified Ashworth Scale（MAS）,the wrist angle of active dorsiextention motion by orthrometer,fine movement quotient（FMQ） by Peabody developmental motor scale（PDMS-Ⅱ）,and activities of daily living（ADL） were performed to evaluate the effects before and 3 months after treatment.Results These outcomes were improved significantly after treatment（P〈0.001）.Conclusion BTX-A injection combined with rehabilitation functional training could rapidly reduce spasticity of the upper extremity,increase the range of motion,improve motor function of upper extremity in children with spastic hemiplegic CP.