超声引导联合体表定位肉毒毒素注射治疗脑卒中后下肢痉挛

Clinical effect of ultrasound combined with anatomy- measure guidance botulinum toxin type A injection in poststroke patients with spasticity

目的评价超声引导联合体表定位技术注射肉毒毒素治疗脑卒中后肌痉挛的效果。方法选择2009年1月至2011年1月在中山大学附属第三医院住院的脑卒中下肢痉挛患者18例，在超声引导联合体表定位技术引导下，将BTXA准确注入靶肌。注射后进行常规康复训练。在注射前、注射后3d、1、2、4及12周时，分别采用改良Ashworth评分、踝关节被动活动度测量、10m步行测试、Berg平衡量表进行相关评价。结果治疗组在注射后1、2、4及12周，肌张力[治疗前（2．6±0．5）分，治疗后12周（1．05±0．29）分]、踝关节被动活动度[治疗前（7．2±2．4）°，治疗后12周（18．6±2．2）°]、10m步行时间[治疗前（55±5）s，治疗后12周（43±4）S]、Berg平衡量表评分[治疗前（34．7±5．1）分，治疗后12周（45．8±2．1）分]均较注射前明显改善（P〈0．05）。结论采用超声引导联合体表定位的肉毒毒素注射技术治疗脑卒中后肌痉挛，定位准确，治疗效果显著。

Objective To evaluate the clinical efficacies of botulinum toxin type A （BTX-A） injection under ultrasonic guidance and body surface positioning in poststroke patients with lower extremities spasticity. Methods From January 2009 to January 2011, a total of 18 patients with stroke-related spasticity in lower extremities were recruited at Third Affiliated Hospital of Sun Yat-sen University. Under the guide of color Doppler ultrasound and body surface positioning, BTX-A was injected into multi-points of muscles. The outcome after BTX-A injection was assessed by modified Ashworth scale （ MAS）, passive range of movement （ PROM）, 10-meter walking test （ 10 MWT） and Berg balance scale （BBS）. Assessments were performed at baseline, Day 3, Weeks 1, 2, 4 and 12 post-injection respectively. Results Compared the scores of MAS （ MASp 2. 6± 0. 5, MASpoost-treatment 1.9 ± 0. 2 - 1.1 ± 0. 3 score） , PROM （ PROMpre-treat 7. 2 ± 2.4°, PROMpost-treament 12. 3±2. 0 - 18. 6 ±2. 2°） between baseline and follow-up at Weeks 1, 2, 4 and 12 post- treatment, there were significant statistical differences （ P 〈 0. 05 ）. 10 MW （ 10 MWTp 55.1 ± 5.2 s, 10MWTp 48.6 ±4.2-42.9 ±3.8 s） and BBS （BBSp 34.7°5.1,BBS 39.9 ±4. 9 --45.8± 2. 1 score） improved greatly at Weeks 2, 4 and 12 post-treatment. Conclusion Ultrasonie guidance and body surfaee positioning is an accurate positioning modality of using BTX-A for treating the spasticity of lower extremities.