A型肉毒素注射对脑卒中后下肢痉挛患者步行功能的影响

Effect of Botulinum Toxin Type A on Motor Function of Patients with Lower Limb Spasticity after Stroke

目的:观察A型肉毒素注射结合康复训练对脑卒中后下肢痉挛患者步行功能的影响,为临床康复治疗提供依据。方法:将2023年2月-2024年2月于十堰市太和医院神经康复科住院治疗的脑卒中患者36例随机分为对照组(18例)和治疗组(18例),对照组给予常规康复训练(运动疗法+物理治疗),治疗组在常规康复锻炼的基础上给予主要伸肌群A型肉毒素(Botulinum Toxin A,BTX-A)注射。所有患者在治疗前及治疗4周后均采用改良Ashworth分级量表(Modified Ashworth Scale,MAS)行下肢肌肉痉挛程度评价,下肢Fugl-Meyer运动功能量表(Lower Limb Fugl-Meyer Assessment,L-FMA)评分行功能状态评价,表面肌电积分值(Surface EMG integral Values,iEMG)行肌肉状态评价,采取Gait watch三维步态分析系统记录患者下肢各关节活动度及时空参数变化。结果:与治疗前相比,治疗4周后,两组患者的MAS评分、下肢FMA评分、iEMG分值较治疗前均有改善(P<0.05),步频、步幅、步速提高(P<0.05),步长偏差和患侧支撑相均缩短(P<0.05),患侧髋、膝关节的最大伸展度及最大屈曲度受限改善(P<0.05),患者步行能力明显提高;且治疗组的肌肉痉挛程度、运动功能评分、步态时空参数较对照组改善更明显(P<0.05),但髋、膝关节活动度未见明显变化。结论:A型肉毒素注射结合康复训练可显著降低脑卒中后偏瘫患者下肢痉挛肌群的肌张力,能有效纠正其偏瘫步态,提高患者步行能力。

Objective To observe the effect of botulinum toxin type A combined with rehabilitation training on the motor function of patients with lower limb spasticity after stroke and to provide evidence for clinical rehabilitation treatment.Meth⁃ods A total of 36 stroke patients treated in the Department of Nerve Rehabilitation,Taihe Hospital,Hubei University of Medicine from February 2023 to February 2024 were selected for the study.They were randomly divided into a control group(18 cases)and a treatment group(18 cases).The control group received routine rehabilitation training(exercise therapy+physical therapy),while the treatment group was given botulinum toxin type A(BTX-A)injection into the main extensor muscle group in addition to routine rehabilitation training.All patients were evaluated using the Modified Ashworth Scale(MAS)for lower limb spasticity,the Lower Limb Fugl-Meyer Assessment(L-FMA)for functional status,and integral values of surface electromyography(iEMG)for muscle status before treatment and after four-week treatment.The Gait watch three-dimensional gait analysis system was used to record the changes in the mobility of lower limb joints and spatio⁃temporal parameters.Results After fours weeks of treatment,both groups showed improvement in MAS score,L-FMA score,and iEMG value compared with the conditions before treatment(P<0.05).There was also an increase in step fre⁃quency,step length,and walking speed(P<0.05),as well as a decrease in step length deviation and single-limb support phase(P<0.05).The ranges of motion of hip and knee joints on the affected side improved compared with those before treatment(P<0.05),resulting in a significant improvement in walking ability.The treatment group was superior to the con⁃trol group in muscle spasticity,motor function scores,and gait spatiotemporal parameters(P<0.05),but no significant change was found in the range of motion of hip and knee joints.Conclusion BTX-A injection combined with rehabilitation training can significantly reduce muscle tension in the spastic muscle group of lower limbs of stroke patients,correcting their hemiplegic gait and improving their walking ability.