重复外周磁刺激联合A型肉毒毒素肌注对痉挛型双瘫患儿下肢运动功能改善的作用

Effect of repetitive peripheral magnetic stimulation combined with intramuscular injection of botulinum toxin type A on the improvement of lower limb motor function in children with spastic diplegia

目的研究重复外周磁刺激联合A型肉毒毒素肌注治疗对痉挛型双瘫患儿下肢运动功能的近期和远期疗效。方法选择2023年1月—2023年6月徐州医科大学附属徐州儿童医院收治的痉挛型双瘫患儿60例,按照随机数字表法分为对照组(30例)和观察组(30例),对照组入组后进行A型肉毒毒素肌内注射和传统综合康复训练,观察组在对照组的基础上增加重复外周磁刺激胫前肌治疗;治疗期间观察组退出1例,最终对照组30例、观察组29例纳入研究。分别在治疗前、治疗3个月及6个月时采用踝关节主动背曲活动度、平衡功能测定(BBS)、粗大运动评估量表(GMFM-88)D、E区评分、小腿三头肌肌张力评估(MAS)评价2组患儿的踝关节主动背曲功能、平衡功能、粗大运动功能以及小腿三头肌的痉挛程度。结果治疗前,2组患儿的踝关节主动背曲活动度、BBS、GMFM-88 D、E区评分、MAS的评分比较差异无统计学意义(P>0.05);2组患儿治疗3个月及6个月时的上述指标均较治疗前改善,对照组和观察组比较差异有统计学意义(P<0.05)。结论重复外周磁刺激应用于A型肉毒毒素肌注后痉挛型双瘫患儿可进一步提高下肢运动功能。

Objective To investigate the short-term and long-term effectiveness of repetitive peripheral magnetic stimulation combined with intramuscular injection of botulinum toxin type A on the lower limb motor function of children with spastic diplegia.Methods A total of 60 children with spastic diplegia who were admitted to Xuzhou Children′s Hospital Affiliated to Xuzhou Medical University from January to June 2023 were selected.According to the random number table method,they were divided into two groups(n=30):a control group and an observation group.The control group was intramuscularly injected with botulinum toxin type A and underwent traditional comprehensive rehabilitation training,while the observation group received repetitive peripheral magnetic stimulation of the tibialis anterior in addition to the treatment provided to the control group.During treatment,1 child in the observation group withdrew,and finally 30 cases in the control group and 29 cases in the observation group were included in the study.Their active range of motion for ankle dorsiflexion,the Berg Balance Scale(BBS)scores,the Gross Motor Function Measure(GMFM-88)scores for regions D and E,and the Modified Ashworth Scale(MAS)scores for triceps surae muscle tone were measured before treatment,and after treatment for 3 and 6 months to evaluate the active ankle dorsiflexion function,balance function,gross motor function,and spasticity of the triceps surae muscle.Results Before treatment,there were no statistical differences between the two groups in active range of motion for ankle dorsiflexion,BBS,GMFM-88 D and E region scores,or MAS scores(P>0.05).Both groups showed improvements in these indicators after treatment for 3 and 6 months compared with those before treatment.The differences between the control and observation groups were statistically significant(P<0.05).Conclusions Repetitive peripheral magnetic stimulation after intramuscular injection of botulinum toxin type A can further improve lower limb motor function in children with spastic diplegia.