不同剂量A型肉毒毒素注射治疗痉挛型脑性瘫痪儿童尖足的疗效研究

Dosage effects in treating tiptoe deformity in children with spastic cerebral palsy using botulinum toxin type A

目的:观察不同剂量A型肉毒毒素(BTX-A)注射联合康复治疗对痉挛型脑性瘫痪患儿尖足的影响。方法:选取脑性瘫痪患儿107例,按照随机数字表法将其分为A组(35例)、B组(36例)、C组(36例)。BTX-A注射在彩色多普勒超声引导下进行,注射剂量分别为3 U/kg、4 U/kg、5 U/kg,注射后每组均给予4个疗程的康复训练。治疗前及治疗后1、3、6个月,采用改良Tardieu量表(MTS)评定腓肠肌痉挛程度,采用粗大运动功能量表-88(GMFM-88)及儿童平衡量表(PBS)评估患儿粗大运动D、E区及平衡功能。结果:治疗后,3组患儿MTS、关节角度R1及R2、PBS、GMFM的D区及E区评分均较组内治疗前有不同程度改善,但组间比较差异无统计学意义(P>0.05)。3组患儿注射BTX-A不良反应率比较,差异无统计学意义(P>0.05)。结论:3 U/kg、4 U/kg、5 U/kg的BTX-A注射联合康复训练均能改善痉挛型脑瘫患儿的尖足状态,但不同剂量的疗效差异无统计学意义,推荐剂量为3 U/kg。

Objective To observe the clinical efficacy and side effects of injecting different doses of botulinum toxin type A(BTX-A)into children with spastic cerebral palsy(CP)and tiptoe deformity.Methods A total of 107 children with tiptoe deformity resulting from CP were divided into group A(n=35),group B(n=36)and group C(n=36)using a random number table.Group A received 3u/kg injections of BTX-A,group B received 4u/kg injections and group C received 5u/kg.The injections were guided by color Doppler ultrasound and followed by 4 courses of rehabilitation therapy.Before and 1,3 and 6 months after the treatment,the modified Tardieu scale(MTS)was used to assess gastrocnemius spasms,while sections D and E of gross motor function scale 88(GMFM-88)and the pediatric balance scale(PBS)were used to evaluate motor functioning and balance.Any side effects were also observed.Results After the treatment,improvement was observed in all of the measurements,though there were no significant differences in the degree of improvement nor in the incidence of side effects among the three groups.Conclusions There is no significant difference in clinical efficacy or side effects involved in using different doses of BTX-A to treat tiptoe deformity in children with spastic cerebral palsy.The recommended dosage is therefore 3u/kg.