肉毒毒素联合康复训练治疗帕金森病患者纹状体足畸形的疗效观察

Supplementing rehabilitation training with botulinum neurotoxin improves outcomes for Parkinson's disease patients with striatal foot deformity

目的观察A型肉毒毒素(BTX-A)注射联合下肢康复训练治疗帕金森病(PD)患者纹状体足畸形(SFD)的疗效。方法采用随机数字表法将68例PD继发SFD患者分为观察组及对照组,每组34例。2组患者均给予常规药物治疗(如多芭类、多巴胺受体激动剂等),对照组患者在此基础上给予下肢康复训练(包括关节被动活动度训练、肌力训练、步行训练等),观察组患者则同时辅以BTX-A注射及下肢康复训练。于治疗前、治疗后7 d、14 d及30 d时分别采用视觉模拟评分法(VAS)、PD综合评分量表-下肢运动功能部分(UPDRS-LLM)、Berg平衡量表(BBS)及改良Barthel指数(MBI)量表对2组患者进行疗效评定。结果治疗后14 d、30 d时对照组SFD评分、疼痛VAS评分、UPDRS-LLM评分、BBS评分及MBI评分均较治疗前明显改善(P<0.05);治疗后7 d、14 d、30 d时观察组SFD评分、疼痛VAS评分、UPDRS-LLM评分、BBS评分及MBI评分均较治疗前及同期对照组明显改善(P<0.05)。结论BTX-A注射联合下肢康复训练能更快改善PD继发SFD患者足趾畸形程度,减轻局部痉挛肌肉张力,缓解痉挛性疼痛,进而提高下肢运动功能、平衡能力及日常生活活动(ADL)能力,且其疗效较单独下肢康复训练更有优势。

Objective To observe any therapeutic effect of combining botulinum toxin type A(BTX-A)with rehabilitation training in treating Parkinson's disease(PD)patients with striatal foot deformity(SFD).Methods A total of 68 PD patients with SFD were randomly divided into a control group and a treatment group.Both groups were given routine medication with pramipexole and dopamine receptor agonists and received lower limb rehabilitation training,including passive activity training,strength training and walking training.The treatment group was additionally injected with BTX-A.Sciatic pain was quantified using a visual analogue scale.The Unified Parkinson's Disease Rating Scale-lower limb motor lower limb motor function(UPDRS-LLM)scale,the Berg balance scale and the modified Barthel index were applied to test all of the participants before the experiment and on the 7th,14th and 30th day of the treatment.Results The average scores of the control group on all of measures at were significantly better than those of the control group at the same time points,and by the 14th and 30th day had improved significantly compared with those before treatment.Conclusion Supplementing rehabilitation training with BTX-A can significantly improve foot deformity and relieve the muscle tension and spastic pain of PD patients with SFD,promoting the motor functioning of their lower limbs,their balance and their performance in the activities of daily living.