肌电图引导下A型肉毒素与选择性脊神经后根切断术治疗痉挛型脑瘫的效果比较

Comparative study on spastic cerebral palsy treated by lectromyography-guided botulinum toxin type A and selective posterior rhizotomy

目的比较研究肌电图引导下A型肉毒素与选择性脊神经后根切断(SPR)术治疗痉挛型脑瘫的效果。方法回顾性分析新疆医科大学第二附属医院脑瘫中心2015年12月~2016年6月收治的40例痉挛型脑瘫患者的临床资料,根据治疗方式分为对照组和观察组;其中对照组20例,采取肌电图引导下A型肉毒素治疗;观察组20例,采取SPR术治疗;对比两组患者的并发症发生情况、治疗前及治疗后不同时间点的综合痉挛量表(CSS)和粗大运动功能量表(GMFM)评分。结果两组患者的并发症发生率比较,差异无统计学意义(P>0.05)。观察组治疗2周后CSS评分开始明显降低,而对照组治疗1个月后CSS评分开始降低;观察组治疗2周,1、3、6个月后CSS评分均低于对照组,降低程度大于对照组,差异有统计学意义(P<0.05)。观察组治疗1个月后GMFM评分开始升高,对照组治疗3个月后GMFM评分开始升高;观察组治疗1、3、6个月后GMFM评分均高于对照组,升高程度大于对照组,差异有统计学意义(P<0.05)。两组患者治疗1、3个月后的小腿三头肌MAS评分、踝关节活动度均较治疗前显著改善,差异有统计学意义(P<0.05);且观察组患者治疗1、3个月后的小腿三头肌MAS评分、踝关节活动度改善程度大于对照组,差异有统计学意义(P<0.05)。结论肌电图引导下A型肉毒素与SPR术治疗痉挛型脑瘫的效果显著,安全性高,在严格手术适应证的基础上,后者在缓解肌肉痉挛、提高患儿粗大运动能力方面较前者更具有优势。

Objective To study the effect of electromyography-guided botulinum toxin type A and selective posterior rhizotomy（SPR） for treatment of spastic cerebral palsy.Methods The clinical data of 40 patients with spastic cerebral palsy were retrospectively analyzed from December 2015 to June 2016 in the Cerebral Palsy Center, the Second Affiliated Hospital of Xinjiang Medical University.According to the treatment method, these patients were divided into the observation group and the control group.There were 20 cases treated with electromyogram-guided botulinum toxin type A in the control group.And there were 20 cases treated with SPR in the observation group.The postoperative complications, the comprehensive spasticity scale（CSS） and the gross motor function scale（GMFM） at different time before and after treatment were compared between the two groups.Results There was no statistical significance between two groups（P〉 0.05）.Two weeks after treatment, the CSS score in the observation group began to decrease.One month after treatment, the CSS score in the control group began to decline.At 2 weeks, 1 month, 3 months and 6 months after treatment, the scores of CSS in the observation group were significantly lower than those in the control group and decreased degree in the observation group were more than those in the control group, with statistically significant difference（P〈 0.05）.One month after treatment, the GMFM score in the observation group began to increase.Three months after treatment, the GMFM score in the control group began to increase.At 1 month, 3 months and 6 months after treatment, the GMFM score in the observation group were significantly more than those in the control group and increased degree in the observation group were more than those in the control group, with statistically significant difference（P 〈0.05）.At 1 month and 3 months after treatment, MAS score for triceps surae and the motion of ankle-joint were significantly improvement compared with those before treatment（P 〈0.05）, and the improvement for MAS score of triceps surae and the motion of ankle-joint in the observation group were more than those in the control group, with statistically significant difference（P 〈0.05）.Conclusion Electromyography guided botulinum toxin type A and SPR for treatment of spastic cerebral palsy are effective and safe.Based on strict operative indications, the latter has advantages of relieving muscle spasm and improving the children＇s motor capacity.