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目的探讨A型肉毒毒素超声定位和徒手肌肉定位联合综合康复锻炼对脑性瘫痪儿童下肢功能的影响。方法选取2012年4月至2015年2月青海省妇女儿童医院和新疆维吾尔自治区人民医院收治的脑性瘫痪儿童89例,依据随机数表法分为观察组(超声定位+综合康复锻炼)和对照组(徒手肌肉定位+综合康复锻炼),比较两组患者治疗前,治疗后2周,1、3、6个月改良Ashowrth痉挛量表评分及粗大运动功能评定量表(GMFM)评分。结果治疗前,两组患者的改良Ashowrth评分、GMFM评分、踝关节背屈度、被动活动度差异均无统计学意义(P>0.05)。治疗后2周,1、3、6个月,两组患者的改良Ashowrth评分逐渐降低,且观察组变化幅度更大(P<0.05)。治疗后2周,1、3、6个月,观察组患者的GMFM评分均明显高于对照组(P<0.05)。治疗后1个月,观察组患者踝关节背屈度明显升高,踝关节被动活动度低于对照组(P<0.05)。结论 A型肉毒毒素超声定位联合综合康复锻炼能够有效改善脑性瘫痪儿童下肢功能,缩短下肢功能恢复时间。
Objective To investigate the effect of botulinum toxin type A ultrasound and manual muscle positioning combined with rehabilitation on lower extremity function in children with cerebral palsy. Methods Eighty-nine children with cerebral palsy admitted from April 2012 to February 2015 in Qinghai Women and Children’s Hospital and Xinjiang Uygur Autonomous Region People’s Hospital were divided into observation group (ultrasound localization + comprehensive rehabilitation exercise) and control (Arm muscle localization + comprehensive rehabilitation exercise). The modified Ashwörth Spasm Scale and Gross Motor Function Rating Scale (GMFM) were compared between the two groups before treatment, two weeks, one, three and six months after treatment. Results Before treatment, there was no significant difference between the two groups in modified Ashowrth score, GMFM score, ankle joint flexion and passive motor activity (P> 0.05). At 2 weeks, 1, 3 and 6 months after treatment, the modified Ashowrth scores decreased gradually in both groups, and the changes in the observation group were more significant (P <0.05). At 2 weeks, 1, 3 and 6 months after treatment, the GMFM scores in the observation group were significantly higher than those in the control group (P <0.05). One month after treatment, the degree of ankle flexion in observation group was significantly higher than that in control group (P <0.05). Conclusion Ultrasound localization of botulinum toxin type A combined with comprehensive rehabilitation can effectively improve the function of lower extremities of children with cerebral palsy and shorten the recovery time of lower limbs.