超声定位引导A型肉毒毒素注射联合常规康复训练治疗痉挛型脑瘫儿童下肢肌张力障碍的疗效观察

Efficacy observation of ultrasound-guided botulinum toxin type A injection combined with routine rehabilitation training on lower limbs dysmyotonia of spastic cerebral palsy children

目的观察超声定位引导A型肉毒毒素(BTX-A)注射联合常规康复训练治疗痉挛型脑瘫儿童下肢肌张力障碍的疗效,为临床康复治疗提供依据。方法选择2014年9月-2015年8月于安徽省儿童医院康复科住院治疗的双下肢痉挛的脑瘫患儿42例作为研究对象,随机分为对照组(21例)和治疗组(21例),对照组给予常规康复训练(运动疗法+物理治疗),治疗组在超声定位引导下予BTX-A注射,次日行常规康复训练。所有患儿分别在治疗前及治疗1、3、6个月采用改良Ashworth修正量表(MAS)和粗大运动功能量表(GMFM)行双下肢肌肉痉挛程度和粗大运动功能的评价。结果两组在治疗1、3、6个月后MAS及GMFM评分均优于治疗前(P<0.05);同时间点治疗组痉挛程度的缓解及运动功能的提高均较对照组明显改善(P<0.05);治疗组MAS评分在3个月与6个月比较差异无统计学意义(P>0.05),BTX-A疗效有一定的时限性。结论运用超声定位引导BTX-A注射治疗痉挛型脑瘫患儿能更好的缓解其双下肢痉挛性肌群的肌张力,改善其运动功能。

Objective To observe the clinical effect of ultrasound-guided botulinum toxin type A（BTX-A）injection combined with routine rehabilitation training on lower limbs dysmyotonia of spastic cerebral palsy children,and to provide evidence for clinical recovery treatment. Methods A total of 42 cases of Cerebral palsy in rehabilitation department of Anhui Provincial Children＇s Hospital from September 2014 to August 2015 were randomly divided into treatment group with 21 cases and control group with 21 cases,the control group received routine rehabilitation training（exercise therapy and physical therapy）,treatment group was treated with BTX-A injection with ultrasound positioning and guidance,and began routine rehabilitation training next day.All patients were evaluated respectively before treatment and one month,three months,six months after treatment,the Modified Ashworth Scale（MAS）and the Gross Motor Function Measure（GMFM）were used as the standard to assess the degree of muscle spasm and gross motor function of lower limbs. Results After one month,three months and six months treatment,the MAS and GMFM scores of two groups were all significantly better than before（P〈0.05）;At the same time point,compared with the control group,the degrees of spasm and motor function in the treatment group were significantly improved（P〈0.05）;The MAS score improvement of treatment group between three months and six months after treatment was statistically significant（P〈0.05）,BTX-A effect had a certain time limit. Conclusion The use of BTX-A with ultrasound in the treatment of spastic cerebral palsy children can relieve the muscular tension,and improve the motor function.