论文部分内容阅读
目的探讨国产A型肉毒素(BTX-A)肌肉注射治疗卒中后痉挛性足下垂的疗效和安全性,特别是功能性改善的疗效。方法采用前瞻性随机对照研究,选取35例脑卒中后难治性、痉挛性足下垂患者为研究对象。患者被随机分为两组:BTX-A+康复治疗组(A组)18例和单纯康复治疗组(B组)17例。采用电刺激(ES)引导的BTX-A注射方法,将BTX-A分别注射到腓肠肌内外侧头,比目鱼肌和胫骨后肌,注射剂量为300或400U。分别于治疗前及治疗后2周、4周时评定踝背伸时改良的Ashworth计分(MAS)、下肢的Fulg-Meyer(FMA-下肢)计分和步速。结果 A组患者中有效率为83.3%。治疗后2周、4周时的MAS显著下降(P<0.05),与对照组相比,分别在治疗后2周、4周时有明显降低(P<0.05)。A组患者的运动功能状态评定:FMA-下肢和步速治疗后虽呈明显提高趋势,但均未达统计学意义(P>0.05)。BTX-A治疗无严重的副作用。结论 BTX-A结合康复治疗能有效缓解跖屈肌痉挛,但对于功能性改善不理想。
Objective To investigate the efficacy and safety of domestic injection of BTX-A intramuscular injection in the treatment of post-stroke spastic dipal ptosis, especially for functional improvement. Methods A prospective randomized controlled study was conducted in 35 patients with refractory and spastic foot-sagging after stroke. Patients were randomized into two groups: 18 in BTX-A + group (group A) and 17 in group B (group B). BTX-A was injected into medial and lateral heads of gastrocnemius muscle, soleus muscle and tibialis posterior muscle by electric stimulation (ES) -based BTX-A injection method. The injection dose was 300 or 400U. Modified Ashworth score (MAS) at ankle dorsiflexion, Fulg-Meyer (FMA-lower limb) score and pace in lower limbs were assessed before treatment and at 2 and 4 weeks after treatment. Results The effective rate in group A was 83.3%. Compared with the control group, MAS decreased significantly at 2 and 4 weeks after treatment (P <0.05). A group of patients with motor function status assessment: FMA-lower limbs and pace although the treatment was significantly improved trend, but did not reach statistical significance (P> 0.05). BTX-A treatment without serious side effects. Conclusion BTX-A combined with rehabilitation therapy can effectively relieve plantar flexor spasm, but not for functional improvement.