肉毒毒素联合生物反馈治疗对痉挛型脑瘫患儿下肢功能的影响

Effects of botulinum toxin type A injection plus biofeedback therapy on motor function in children with spastic cerebral palsy

目的 观察A型肉毒毒素注射联合生物反馈治疗对痉挛型脑瘫患儿下肢运动功能障碍的疗效.方法 从2011年2-12月在上海交通大学医学院附属新华医院康复科就诊的脑瘫患儿中选择31例痉挛型脑瘫患儿,按就诊顺序分为2组,观察组15例接受A型肉毒毒素注射,注射后第2天开始进行包括生物反馈在内的康复治疗；对照组16例只做常规康复治疗.患儿入选后分别在治疗前、治疗后第3、7、14、30、90天时评定：改良Ashworth量表（MAS）、综合痉挛量表（CSS）、踝关节被动背伸活动范围（PROM）；在疗前、治疗后第90天时评估：粗大运动功能量表（GMFM-88）、步行速度.结果 观察组患儿治疗前和治疗后第3、7、14、30、90天的MAS评分分别为2.6±0.6、2.0±0.5、1.2±0.5、0.6±0.6、0.5±0.6、1.0±0.5,CSS评分分别为14.1±1.1、12.0±1.1、10.2±1.2、8.2±1.4、8.0±1.5、9.0±1.6,PROM分别为（-8.5±9.4）°、（-1.5 ±7.6）°、（6.9±8.3）°、（11.7±6.8）°、（15.2±6.6）°、（13.7±7.8）°,治疗后较治疗前均有显著改善（P＜0.01）.对照组患儿CSS评分自治疗后第7天开始改善,与治疗前比较差异均有统计学意义（P＜0.05）,MAS评分、PROM在治疗后第14天开始改善,与治疗前比较差异均有统计学意义（P＜0.05）.MAS评分、CSS评分、PROM在治疗后各观测时间点组间差异有统计学意义（P＜0.01）.两组患儿粗大运动功能、步行速度在治疗后第90天均较治疗前有显著改善,差异有统计学意义,观察组P＜0.01,对照组P＜0.05,且两组间差异有统计学意义（P＜0.05）.结论 A型肉毒毒素注射联合生物反馈治疗能快速有效地提高痉挛型脑瘫患儿的下肢运动功能.

Objective To explore the effects of botulinum toxin-A （BTX-A） injection plus biofeedback therapy on lower limb motor function with spastic cerebral palsy.Methods A total of 31spastic cerebral palsy children from February to December 2012 were divided into observation group （n =15） and control group （n =16） respectively.All cases received systematic rehabilitation therapy for 3months.The observation group was injected with BTX-A at baseline and received biofeedback therapy and other rehabilitations at Day 1 post-injection.Modified Ashworth scale （MAS）,composite spasticity scale （CSS） and passive range of ankle motion （PROM） were assessed at baseline,Days 3,7,14,30 and 90post-therapy.And gross motor function measure-88 and walking velocity were examined at baseline and Day 90 post-therapy.Results In observation group,the MAS pre-and 3,7,14,30,90 d post-treatment were 2.6±0.6,2.0 ±0.5,1.2 ±0.5,0.6 ±0.6,0.5 ±0.6,1.0 ±0.5;CSS were 14.1 ± 1.1,12.0± 1.1,10.2 ± 1.2,8.2 ± 1.4,8.0 ± 1.5,9.0 ± 1.6 respectively ; PROM were （-8.5 ± 9.4） °,（-1.5 ± 7.6） °,（6.9 ± 8.3） °,（11.7 ± 6.8） °,（15.2 ± 6.6） °,（13.7 ± 7.8） ° respectively.All children showed significant decreases in spasticity （MAS,CSS,PROM） and improvements in GMFM and walking velocity.And the difference of children in observation group was earlier than that in control group.Statistically significant differences existed between two groups in MAS,CSS and PROM （P 〈 0.01）.There were also statistically significant differences between two groups in GMFM-88,stand and walking function scores,walking velocity （P 〈 0.05）.Conclusion BTX-A injection plus biofeedback therapy can quickly and effectively improve lower extremity motor function in children with spastic cerebral palsy.