胫神经腓肠肌分支乙醇阻滞术对上运动神经元损伤后腓肠肌痉挛的影响

Effects of alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle on gastrocnemius spasticity in patients with upper motor neuron injury

目的观察胫神经腓肠肌分支乙醇阻滞术治疗上运动神经元(UMN)损伤后腓肠肌痉挛的临床结果。方法入选50例符合纳入标准的UMN损伤病人,随机分为注射组和对照组各25例,注射组行电刺激引导下胫神经腓肠肌分支乙醇阻滞术,并予康复训练,对照组仅行康复训练,分别在治疗前、治疗后1周、1个月、3个月、6个月进行改良Ashworh(MAS)评分、踝阵挛评分(Clonus)、踝背屈被动关节活动范围(PROM)、10 m步行测定(10m-WT)、步行中踝背屈最大角度(AROM)及步态功能视觉类比评定(VAS-GF)等测试,并记录注射组注射后不良反应。结果治疗后1周,注射组MAS、Clonus、PROM、10m-WT、VAS-GF均明显改善(P<0.05),对照组仅PROM有明显提高(P<0.05)。治疗后1个月、3个月及6个月,注射组各指标均明显改善(P<0.05)。对照组治疗后1个月,10m-WT、VAS-GF明显提高(P<0.05);治疗后3个月、6个月,Clonus、10m-WT与VAS-GF明显改善。治疗后2组间各时间点MAS、PROM、Clonus与10m-WT比较差异均具有统计学意义(P<0.05)。注射组所有病人未出现严重不良反应。结论胫神经腓肠肌分支乙醇阻滞术治疗UMN损伤后腓肠肌痉挛安全有效。

Objective To evaluate the effects of alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle in the treatment of gastrocnemius spasticity in the patients with upper motor neuron(UMN) injury.Methods Fifty patients who were included in this study were randomly divided into two groups.The injection group(n = 25) received motor branch block(MBB) of the tibial nerve to the gastrocnemius muscle and rehabilitation treatment.The rehabilitation group(n = 25) received rehabilitation only.The severity of spasticity was assessed before and after treatment,through detecting Modified Ashworth Scale(MAS) score of gastrocnemius muscle,clonus score of ankle,passive range of motion(PROM) of ankle dorsiflexion,a timed 10 meters walk(10 m-WT),maximum of the active range of motion of ankle dorsiflexion during walking,and visual analogue scale of gait founction(VAS-GF).The complications were observed during the 6-month follow-up period.Results One week after treatment,the levels of MAS,Clonus,PROM,10 m-WT,VAS-GF in the injection group were significantly improved(P<0.05),while only PROM in the control group was significantly improved(P<0.05).One month,3 months and 6 months after treatment,all indexes in the injection group were significantly improved(P<0.05).In the control group,10 m-WT and VAS-GF were significantly increased 1 month after treatment(P<0.05),and Clonus,10 m-WT and VAS-GF were significantly improved 3 months and 6 months after treatment.Compared with the control group,MAS,PROM,Clonus and 10 m-WT in the injection group all showed statistically significant differences(P< 0.05) after treatment.No serious adverse reactions occurred in all patients in the injection group.Conclusions MBB of the tibial nerve to the gastrocnemius muscle is effective and safe in relieving gastrocnemius muscle spasticity in the patients with UMN injury.