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目的观察超声定位引导A型肉毒毒素(BTX-A)注射联合常规康复训练治疗痉挛型脑瘫儿童下肢肌张力障碍的疗效,为临床康复治疗提供依据。方法选择2014年9月-2015年8月于安徽省儿童医院康复科住院治疗的双下肢痉挛的脑瘫患儿42例作为研究对象,随机分为对照组(21例)和治疗组(21例),对照组给予常规康复训练(运动疗法+物理治疗),治疗组在超声定位引导下予BTX-A注射,次日行常规康复训练。所有患儿分别在治疗前及治疗1、3、6个月采用改良Ashworth修正量表(MAS)和粗大运动功能量表(GMFM)行双下肢肌肉痉挛程度和粗大运动功能的评价。结果两组在治疗1、3、6个月后MAS及GMFM评分均优于治疗前(P<0.05);同时间点治疗组痉挛程度的缓解及运动功能的提高均较对照组明显改善(P<0.05);治疗组MAS评分在3个月与6个月比较差异无统计学意义(P>0.05),BTX-A疗效有一定的时限性。结论运用超声定位引导BTX-A注射治疗痉挛型脑瘫患儿能更好的缓解其双下肢痉挛性肌群的肌张力,改善其运动功能。
Objective To observe the effect of ultrasound-guided BTX-A injection combined with routine rehabilitation training on dystonia of lower extremities in children with spastic cerebral palsy, and provide basis for clinical rehabilitation. Methods From September 2014 to August 2015, 42 children with cerebral palsy who suffered from spasms of lower extremity hospitalized in Department of Rehabilitation, Children’s Hospital of Anhui Province were randomly divided into control group (n = 21) and treatment group (n = 21) , The control group was given routine rehabilitation training (exercise therapy + physical therapy), the treatment group under the guidance of ultrasound positioning to BTX-A injection, the next day routine rehabilitation training. All children were evaluated before and 1, 3 and 6 months of treatment with Modified Ashworth Modified Scale (MAS) and Gross Motor Function Scale (GMFM) for muscle spasticity and gross motor function of both lower extremities. Results The scores of MAS and GMFM in both groups after treatment for 1, 3 and 6 months were better than those before treatment (P <0.05). At the same time point, the alleviation of the degree of spasticity and the improvement of motor function in the treatment group were significantly better than those in the control group <0.05). There was no significant difference in the MAS scores between the 3-month and 6-month treatment groups (P> 0.05). The efficacy of BTX-A was somewhat limited. Conclusion The use of ultrasound-guided BTX-A injection in children with spastic cerebral palsy can better alleviate the muscle tension of the spastic muscles of both lower limbs and improve their motor function.