重复经颅磁刺激联合重复注射A型肉毒毒素对脑卒中后下肢肌肉痉挛状态的临床疗效和安全性研究

Long term efficacy and safety of repetitive transcranial magnetic stimulation combined with repeated injection of botulinum toxin type A in the treatment of spasticity of lower limb muscles spasm after stroke

目的观察脑卒中后下肢肌肉痉挛患者行重复经颅磁刺激(rTMS)联合A型肉毒毒素(BTX-A)重复注射的治疗效果及安全性。方法选择2013年7月至2016年7月于本院康复科治疗的伴有下肢肌肉痉挛的脑卒中患者共96例,按照随机数字表法分为4组:A组,康复治疗;B组,rTMS+康复治疗;C组,重复注射BTX-A+康复治疗;D组,rTMS+重复注射BTX-A+康复治疗。治疗前及治疗后1、6和12个月对4组患者采用改良Ashworth痉挛量表(MAS)评定肌张力,Fugl-Meyer下肢运动功能量表(FMA)评定下肢运动功能,采用改良Barthel指数量表(MBI)评定患者日常生活能力,Berg平衡量表(BBS)评定患者平衡能力。并观察患者在治疗的过程中的不良反应情况。结果与治疗前相比,治疗后1、6、12个月,B、C、D组的MAS评分呈下降趋势,D组最为明显(P<0.05);4组患者治疗1个月后FMA评分、MBI评分、BBS评分均升高,治疗后6、12个月,A、B、C组的FMA评分、MBI评分、BBS评分有下降或回升,D组的评分都呈上升趋势,均高于其他3组(P<0.05);治疗过程中,4组均无严重不良反应情况发生。结论 rTMS联合重复注射A型肉毒毒素能够有效降低脑卒中后下肢肌肉痉挛患者的肌肉张力,提高患者的生活质量,治疗效果较为持久,无不良反应,有临床应用价值。

Objective To observe the curative effect and safety of lower limb spasticity after stroke in patients with repetitive transcranial magnetic stimulation(rTMS)combined with repeated injection of botulinum toxin type A(BTX-A)in the treatment of spasticity of lower limb muscles spasm after stroke.Method 96 cases with lower limb muscle spasm after stroke,who came to rehabilitation department for the treatment from July 2013 to July 2016,were selected.And they were divided into four groups according to the random number table:Group A:rehabilitation treatment,Group B:rTMS+rehabilitation treatment,Group C:repeated injection of BTX-A+rehabilitation treatment,Group D:rTMS+repeated injection of BTX-A+rehabilitation treatment.Before treatment and 1,6 and 12 months after treatment,the MAS scale was used to assess muscle tension,the FMA scale was used to evaluate the motor function of lower limbs,the MBI scale was used to assess the daily living ability of the patients of four groups,the BBS scale was used to assess the balance ability of patients,and the incidence of adverse reactions in the treatment of patients was observed.Results At 1,6 and 12 months after treatment,the MAS scores of B,C and D groups showed a downward trend compared with before treatment,and the D group was the most obvious(P<0.05);After 1 months of treatment,the FMA scores,MBI scores and BBS scores of 4 groups were increased;At 6 and 12 months after treatment,the FMA scores,MBI scores and BBS scores of A,B and C groups decreased or recovered,and the scores of D group showed an upward trend,which were higher than those of the other 3 groups(P<0.05);In the course of treatment,there were no serious adverse reactions in the 4 groups.Conclusion rTMS combined with repeated injection of botulinum toxin type A can effectively reduce the muscle tension of patients with lower limb muscle spasm after stroke,improve the quality of life of patients,and the treatment effect is more durable,has no adverse reactions,it is worthy of clinical promotion.