A型肉毒毒素局部注射对脑卒中患者下肢肌痉挛和步行能力的改善作用

Improvement effect of botulinum toxin A injection treatment on spasticity of triceps surae and walking ability of patients with stroke

目的:采用A型肉毒毒素局部注射脑卒中患者偏瘫侧小腿三头肌,观察其对下肢肌痉挛和步行能力的影响,探讨肌张力变化与下肢运动功能的关系,研究其在社区康复中应用的可行性。方法:选取脑卒中小腿三头肌痉挛患者30例,按照患者意愿分为治疗组(n=15)和对照组(n=15)。治疗组患者小腿三头肌局部注射A型肉毒毒素后进行常规康复治疗,对照组患者仅进行常规康复治疗。常规康复训练包括偏瘫侧下肢肌肉牵伸、肌力训练、平衡训练和步行训练。治疗前后进行康复评定并于治疗后3个月随访评定。肌张力评定采用改良Ashworth痉挛量表(MAS),下肢运动功能评定采用Fugl-Meyer(FM)量表中的下肢部分,步行能力评定采用10米步行测试(10MWT)时间。结果:组内比较,治疗组患者治疗后和治疗后3个月MAS评分低于治疗前(P<0.05);对照组患者治疗前后MAS评分比较差异无统计学意义(P>0.05),治疗后3个月MAS随访评分低于治疗前(P<0.05)。2组患者治疗后和治疗后3个月随访FMA评分、10MWT时间均高于治疗前(P<0.05)。组间比较,治疗组患者治疗后和3个月随访MAS评分低于对照组(P<0.05),而FMA评分、10MWT时间明显高于对照组(P<0.05)。结论:A型肉毒毒素局部注射可快速而持久降低肌张力,结合康复训练可有效改善下肢痉挛状态,提高患者的运动功能和步行能力,适合在社区康复中推广应用。

Objective：To observe the effect of botulinum toxin A injection treatment on the spasticity of triceps surae and walking ability of the patient with stroke,and to discuss the relationship between the muscle tension changes and motor function of lower limb and the feasibility of its application in the community rehabilitation.Methods：Thirty stroke patients with triceps surae spasticity were divided into treatment group（n=15）and control group（n=15）according to the patient＇s will.In treatment group,the botulinum toxin A were injected into the triceps surae of patients before routine physical therapy,while the patients in control group only received routine physical therapy,including muscular stretching,treatment of muscle strength,balance function and walking ability.The modified Ashworth scale（MAS）,Fugl-Meyer Assessment（FMA）and 10-meter walk test（10MWT）time were used to detect the ability of lower limb.All the test was performed before,after,and 3months after the treatment.Results：The MAS scores of the patients in treatment group after treatment and 3months after treatment were lower than that before treatment（P〈0.05）;there was no significant difference of MAS scores of the patients in control group after treatment（P〉0.05）,and the MAS score of patients 3months after treatment was lower than that before treatment（P〈0.05）.The FMA score and 10 MWT time of the patients in two groups after treatment and 3months after treatment were higher than those before treatment（P〈0.05）.Compared with control group,the MAS scores and 10 MWT time of the patients in treatment group after treatment and 3months after treatment were decreased and the FMA scores were increased（P〈0.05）.Conclusion：The botulinum toxin A treatment combined with routine physical therapy may improve the spasticity of triceps surae,gait,and walking ability in a better way,which can be applied in the community rehabilitation.