肉毒素注射联合康复训练对脑瘫患儿拇指内收的疗效观察

Clinical observation of botulinum toxin injection combined with rehabilitation training on thumb adduction in children with spastic cerebral palsy

目的观察肉毒素注射联合针刺及手功能训练改善痉挛型脑瘫患儿拇指内收的疗效。方法选择2016年1月至2018年12月在西安中医脑病医院住院的痉挛型脑瘫伴有拇指内收患儿80例为研究对象,按照随机数字表法将其分为治疗组(40例)和对照组(40例)。对照组单纯用作业疗法治疗,治疗组在B超引导下肉毒素注射3天后行作业疗法和针刺疗法治疗,治疗前后采用主动关节活动度量表(AROM)、精细运动功能量表(FMFM)C区进行疗效评价,并进行分析。结果治疗60天后,治疗组和对照组患儿的AROM和FMFM C区评分均显著高于治疗前(t值分别为17.72、8.55、4.08、2.61,均P<0.05),且治疗后治疗组患儿的AROM和FMFM C区评分均显著高于对照组(t值分别为8.81、2.32,均P<0.05)。治疗组的治疗有效率为92.5%(37/40),显著高于对照组的70.0%(28/40),χ^(2)=8.06,P<0.05。结论肉毒素注射加针刺联合手功能训练改善痉挛型脑瘫患儿拇指内收的疗效显著,值得临床推广应用。

Objective To observe the clinical effect of botulinum toxin injection combined with acupuncture and hand function training on improving thumb adduction in children with spastic cerebral palsy.Methods Eighty children of spastic cerebral palsy with thumb adduction who were hospitalized in Xi’an Traditional Chinese Medicine Brain Disease Hospital from January 2016 to December 2018 were selected as the research subjects,all of them were divided into treatment group and control group according to the random number method,with 40 cases in each group.The control group were treated with occupational therapy alone,while the treatment group were injected with botulinum toxin guided by B-ultrasound,three days later the treat of acupuncture and occupational therapy were added.Before and after treatment,Active Range of Motion(AROM)scale and C area of Fine Motor Function Measure(FMFM)scale were used to evaluate the efficacy,and the results were analyzed.Results After 60 days of treatment,the scores of AROM and C area of FMFM of the two groups were higher than before treatment(t=17.72,8.55,4.08 and 2.61,respectively,all P<0.05).And the AROM and C area of FMFM scores were higher in treatment group than those in control group(t=8.81 and 2.32,respectively,both P<0.05).The effective rate of children in treatment group was 92.5%(37/40),which was higher than that in control group(70.0%,28/40)(χ^(2)=8.06,P<0.05).Conclusion Botulinum toxin injection plus acupuncture combined with hand function training has obvious effects on improving thumb adduction in children with spastic cerebral palsy,which is worthy of clinical application.