不同定位技术联合强化康复训练对脑瘫患儿下肢痉挛的影响

The effect of different localizing techniques in guiding botulinum toxin injection in the treatment of lower limb spasticity in cerebral palsy children

目的观察徒手肌肉定位和超声引导下注射A型肉毒毒素（BTX—A）联合强化康复训练对脑瘫患儿下肢痉挛的影响。方法按照随机数字表法将61例下肢痉挛脑瘫患几分为徒手定位组（31例）和超声引导组（30例），2组患儿均接受BTX-A注射，注射部位均为内收肌、胭绳肌、小腿三头肌。徒手定位组采用徒手定位注射，超声引导组在超声引导下给予BTX—A注射，并在注射后第3天进行强化康复训练。注射前、注射后12周，采用改良Ashworth量表（MAS）、粗大运动功能量表（GMFM）评分对2组患儿的下肢痉挛进行评定。结果注射前，2组患儿MAS、GMFM评分之间比较，差异无统计学意义（P〉0．05）。注射后12周，2组患儿MAS均较组内注射前降低（P〈0．05），且超声引导组注射后12周MAS评分[（1．43±0．50）分]低于徒手定位组[（1．77±0．56）分]（P〈0．05）。注射后12周，2组患儿GMFM评分较组内注射前升高（P〈0．05），且超声引导组注射后12周GMFM评分[（72．43±10．50）分]高于徒手定位组[（67．10±11．25）分]（P〈0．05）。结论超声引导下注射BTX-A联合强化康复训练能显著降低下肢痉挛脑瘫患儿的肌张力，增加其关节活动度，提高运动功能，改善姿势步态。

Objective To observe the effect of free muscle localization and ultrasound-guided injection of botulinum toxin type A （BTX-A） combined with rehabilitation training on lower limb spasm of cerebral palsy chil- dren. Methods Sixty-one cerebral palsy children with lower limb spasticity were randomly divided into a manual localizing group （31 cases） and an ultrasound-guided group （30 cases）. The children of both groups underwent BTX-A injection at adductors, hamstrings and calf triceps. The former group was injected with bare hands, while the latter was injected under the guidance of ultrasound. Both groups were administered with rehabilitation training from the 3rd day onwards after injection. Before and 12 weeks after the injection, the modified Ashworth scale （MAS） and gross motor function scale （GMFM） were used to evaluate the lower limb spasticity and function in 2 groups. Results Before the injection, there was no significant difference between the 2 groups in terms of MAS and GMFM scores （ P 〉 0.05）. However, 12 weeks after the injection, the average MAS scores of the two groups decreased, and that of the ultrasound-guided injection group （ 1.43 ± 0.50） was significantly lower than that of the manual localizing group （ 1.77 ± 0.56）. After the injection, the average GMFM scores of both groups increased, and that of the ultrasound-guided injection group was significantly higher than the manual localizing group （67. 10 ± 11. 25 ）. Conclusion Ultrasound-guided injection of BTX-A with intensive rehabilitation training can significantly reduce the lower limb spasticity in children with cerebral palsy, and increase their motion of joint and motor function, and improve their posture and gait.