A型肉毒毒素与系列石膏治疗脑性瘫痪儿童小腿三头肌痉挛的随机对照研究

A Randomized Controlled Study of Botulinum Toxin Type A and Serial Casting in Treatment of Calf Muscles Spasticity in Children with Cerebral Palsy

目的:探究A型肉毒毒素、系列石膏及A型肉毒毒素注射后继续系列石膏三种治疗方案对脑性瘫痪儿童小腿三头肌痉挛的疗效差异情况。方法:2019年1月至12月于我院儿童康复科收治的符合纳入标准的痉挛型脑瘫患儿为研究对象,随机为三组。A组单独给予A型肉毒毒素注射治疗;B组单独给予系列石膏治疗;C组先给予A型肉毒毒素注射治疗,两周后再给予系列石膏治疗。在治疗前及治疗后1周、4周、12周时,采用踝关节被动关节活动范围测量,粗大运动功能量表,足底压力分布测试及观察性步态量表进行功能评价记录并比较分析。结果:治疗前后各时间点功能评价结果显示:治疗前后各组组内比较存在显著性差异(P<0.001);治疗前后各组组间比较中,时间因素存在显著性差异(P<0.001);粗大运动功能测试结果组间比较显示分组因素无显著性差异(P>0.05),其他三项评价结果组间比较均显示分组因素存在显著性差异(P<0.05);时间与分组的交互性作用均存在显著性差异(P<0.05)。结论:A型肉毒毒素注射后间隔系列石膏的疗效最显著,且疗效持续时间最持久。

Objective:To explore the difference in the effect of three treatment options of botulinum toxin type A,serial casting,and serial casting after injection of botulinum toxin type A on spasticity of calf muscles in children with cerebral palsy.Methods:From January to December 2019,three group(sgroup A:26 cases;group B:24 cases;group C:21 cases)of 71 cases with calf muscles spasticity were finally included.Group A was treated with botulinum toxin type A injection alone;group B was treated with serial casting alone;group C was treated with botulinum toxin type A injection first,and then with serial casting two weeks later.Before the implementation of the three different treatment programs and at 1 week,4 weeks,and 12 weeks after the treatment,the passive ankle joint range of motion measurement,gross motor function measure,plantar pressure distribution test,and observational gait scale were used for measurement and comparison in and between groups.Results:The three groups measure results showed:There were significant differences within each group before and after treatment(P<0.001);in the comparison between the groups before and after the treatment,there were significant differences in the time factors(P<0.001);the comparison of the gross motor function measure results between the groups showed no significant differences in the grouping factors(P>0.05),the other three measurement results showed that there were significant differences in grouping factors(P<0.05);there were significant differences in the interaction between time and grouping factors(P<0.05).Conclusion:The effect of interval serial casting after injection of botulinum toxin type A is better than using one of the methods alone.