系列石膏联合肉毒毒素在脑瘫患儿马蹄足畸形的治疗作用

Combining serial casting with botulinum toxin A in the treatment of spastic equinus in children with cerebralpalsy

目的观察和比较系列石膏联合肉毒毒素和单独使用肉毒毒素注射治疗脑瘫患儿马蹄足畸形的疗效。方法将人选的脑瘫患儿60例按患儿接受治疗的先后顺序编号，采用半随机对照的方法将编号为单数的患儿纳入实验组，编号为偶数的患儿纳入对照组，每组30例。2组患儿均接受肉毒毒素注射治疗，实验组则增加系列石膏治疗。于治疗前、治疗后1个月、治疗后3个月和治疗后6个月观察其踝关节在伸膝和屈膝时的背屈度，并行观察性步态分析。结果治疗前，2组患者间的伸膝时踝关节背屈度、屈膝时踝关节背屈度和观察性步态量表评分差异无统计学意义（P〉0．05），治疗后1、3和6个月，2组患者在伸膝时踝关节背屈度、屈膝时踝关节背屈度和观察性步态量表评分分别与组内治疗前比较，差异均有统计学意义（P〈0．05），实验组在治疗后1、3和6个月的伸膝时踝关节背屈度、屈膝时踝关节背屈度和观察性步态量表评分分别与对照组同时间点比较，差异均有统计学意义（P〈0．05）。结论系列石膏联合肉毒毒素注射疗法比单独使用肉毒毒素治疗痉挛型脑瘫患儿马蹄足畸形的疗效更好，可更好地降低患儿肌肉痉挛的程度，改善关节活动度和步态，疗效持续时间更长。

Objective To compare the effect of injection with botulinum toxin type A （BTX-A） before seri al casting with BTX-A injection alone for the treatment of spastic equinus in children with cerebral palsy （ CP）. Methods Sixty patients were divided into an experimental group and a control group with 30 patients in each. Those in the exper;,mental group received a BTX-A injection followed by serial casting, while the controls received BTX-A only. Before treatment and 1 month, 3 months and 6 months after treatment, the dorsiflexion range of motion （ROM） of the ankle recorded while the knee in flexion and extension were measured, and gait was evaluated with an observa tional gait scale. Results Before treatment there was no significant inter-group difference in any of the 3 outcome measures. At 1 month, 3 months and 6 months after treatment, there were significant intergroup differences in all 3 measures, and also significant differences compared with before treatment in both groups. Conclusion Lower mus cle tone, greater ankle mobility and better gait patterns can be promoted in CP children with spastic equinus using se rial casting combined with BTX-A injection. The improvements may last longer than those after BTX-A injection alone.