超声引导下A型肉毒毒素注射治疗脑卒中后肌痉挛的临床疗效

Clinical effect of ultrasound-guided injection of botulinum toxin type A in the treatment of post-stroke spasticity

目的探讨超声引导下注射A型肉毒毒素治疗脑卒中后肌痉挛(PSS)的临床疗效。方法选取2018年1月至2019年12月本院收治的60例PSS患者作为研究对象,按随机数字表法分为3组,各20例。空白组给予常规康复治疗,对照组给予徒手注射A型肉毒毒素治疗,观察组给予超声引导下注射A型肉毒毒素治疗,比较3组治疗前及治疗2、4周后的痉挛情况、Barthel指数量表(BI)评分、表面肌电积分值(iEMG)及对照组与观察组的不良反应发生情况。结果治疗2、4周后,3组改良Ashworth痉挛量表(MAS)等级均优于治疗前,且观察组优于对照组及空白组,差异有统计学意义(P<0.05)。治疗前及治疗2、4周后,3组BI评分呈递增趋势,且观察组BI评分高于对照组及空白组,对照组高于空白组,差异有统计学意义(P<0.05)。治疗2、4周后,3组iEMG均低于治疗前,且观察组低于对照组及空白组,差异有统计学意义(P<0.05)。观察组与对照组治疗过程中均无不良反应发生。结论相较于常规康复治疗及徒手注射A型肉毒毒素治疗,超声引导下A型肉毒毒素注射治疗PSS效果显著,可有效改善患者痉挛情况,提高其日常生活活动能力,改善肌张力,且安全性较高,值得临床推广应用。

Objective To explore the clinical effect of ultrasound-guided injection of botulinum toxin type A in the treatment of post-stroke spasticity(PSS).Methods 60 patients with PSS admitted to our hospital from January 2018 to December 2019 were selected as the research subjects,and they were divided into three groups according to the random number table method,with 20 cases in each group.The blank group was given routine rehabilitation treatment,the control group was given botulinum toxin type A injection with free-hand,and the observation group was given botulinum toxin type A injection under the guidance of ultrasound,the spasticity,Barthel index scale(BI)score,surface electromyography score(iEMG)before and after treatment for 2 and 4 weeks and adverse reactions between the control group and the observation group were compared.Results After 2 and 4 weeks of treatment,the modified ashworth scalemas(MAS)level of the three groups was better than before treatment,and the observation group was better than that of the control group and the blank group,the differences were statistically significant(P<0.05).Before treatment and after 2 and 4 weeks of treatment,the BI scores of the three groups showed an increasing trend,the BI scores of the observation group was higher than that of the control group and the blank group,the control group was higher than that of the blank group,the differences were statistically significant(P<0.05).After 2 and 4 weeks of treatment,the iEMG of the three groups was lower than that before treatment,and the observation group was lower than the control group and the blank group,the difference was statistically significant(P<0.05).There were no adverse reactions in the observation group and the control group during the treatment.Conclusion Compared with conventional rehabilitation therapy and free-hand injection of botulinum toxin A,ultrasound-guided injection of botulinum toxin type A has significant effect on PSS,which can effectively improve patients'spasticity,improve their activities of daily living,and improve muscle tone,and with high safety,it is worthy of clinical application.