体外冲击波结合肉毒素治疗脑瘫儿童马蹄内翻足

Clinical effect of extracorporeal shock wave combined with botulinum toxin on talipes equinovarus in children with cerebral palsy

目的比较体外冲击波联合肉毒毒素和单独使用肉毒毒素注射治疗脑瘫患儿马蹄足畸形的疗效。方法将接受肉毒素注射治疗的痉挛型患儿40例，按其接受肉毒素治疗的先后顺序进行排序，采用随机数字表法将患儿分为实验组和对照组，每组20例。两组患儿均接受肉毒毒素注射治疗，实验组于接受注射治疗后第2天，给予低能量体外冲击波治疗。于治疗前及治疗后1、3、6个月观察患者小腿三头肌痉挛程度（MAS评分法）及踝关节在伸膝时的背屈度。结果治疗前两组患者小腿三头肌肌张力MAS评分、伸膝时踝关节背屈度比较差异未见统计学意义（P〉0．05）；治疗后1、3、6个月，两组患者小腿三头肌肌张力MAS评分及伸膝时踝关节背屈度分别与同组治疗前比较，差异均有统计学意义（P〈0．05）；实验组治疗前（基线水平），治疗后1、3、6个月的小腿三头肌肌张力MAS评分、伸膝时踝关节背屈度分别与对照组同时间点比较，差异均有统计学意义（P〈0．05）。结论体外冲击波结合肉毒素注射疗法比单独使用肉毒素治疗痉挛型脑瘫患儿马蹄足畸形的疗效更好，可更好地降低脑瘫患儿小腿三头肌肌肉痉挛的程度，改善关节活动度，疗效持续时间更长。

Objective To compare the effects of extracorporeal shock wave combined with botulinum toxin or botulinum toxin injection alone on talipes equinovarus in children with cerebral palsy. Methods Forty spastic children with botulinum toxin injection were sorted according to the order of botulinum toxin treatment, and were divided into the experimental group and the control group, with 20 cases in each group by random number table method. All the patients in the two groups were treated with botulinum toxin injection. The patients in the experimental group were treated by low energy extracorporeal shock wave the second day after the injection. One month before and after the treatment and 3 months and 6 months after the treatment, the degree of spasm of the triceps of the calf （ MAS score） and the back flexion of the ankle joint during the knee extension were examined. Results There was no significant difference in the MAS score of the leg triceps muscle tension between the two groups and the flexion of the ankle joint at knee extension between the two groups of patients before treatment （P 〉 0.05 ）. One month, 3 months and 6 months after the treatment, there were significant differences between the two groups in the MAS scores of the leg triceps muscle tension and the degrees of flexion of ankle joint at knee extension, compared with those before the treatment （P 〈 0.05）. Before the treatment and one month, 3 months and 6 months, there were significant differences in the MAS scores of the leg triceps muscle tension and the degrees of flexion of ankle joint at knee extension in the experiment group, compared with those in the control group at the same time point （P 〈 0.05 ）. Conclusions The effect of extracorporeal shock wave combined with botulinum toxin injection is better than botulinum toxin alone on talipes equinovarus in children with cerebral palsy, and can better reduce the degrees of spasmodic spasm of the triceps muscle in the calf and improve joint mobility, and the curative effect lasts longer.