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目的探讨A型肉毒毒素(botulinum toxin,BTX-A)联合自家康复训练治疗痉挛型脑瘫的临床疗效和经济学价值;初步探索步态分析仪在小儿脑瘫治疗效果评价中的作用。方法选择148例痉挛型脑瘫患儿分治疗组(83例)和对照组(65例),另选30例运动正常非脑瘫患儿作为正常组。治疗组自家康复训练辅以痉挛肌肉注射BTX-A,对照组由康复医师进行康复,观察2组患儿运动评价量表(physician rating scale,PRS)得分和所需医疗费用的变化。采用步态分析试验平台,对从治疗组中随机选择的30例患儿进行治疗前和治疗后1个月的疗效评价并与正常组进行比较。结果两种方法所需费用,治疗组明显低于对照组(P<0.000);治疗3个月和6个月后,治疗组PRS评分改善情况明显优于对照组(P<0.000);步态分析仪统计结果显示,治疗1个月后治疗组患者的膝、踝关节运动角度和步速改善情况较治疗前明显改善(P<0.05)与正常组比较差异无统计学意义。结论康复治疗联合BTX-A局部注射,较单纯康复治疗疗效好;费用较专业康复明显降低,简单易行;采用步态分析仪评价疗效,客观性强,结果可靠、准确。
Objective To investigate the clinical efficacy and economic value of botulinum toxin type A (BTX-A) combined with self-rehabilitation training in the treatment of spastic cerebral palsy. To explore the role of gait analyzer in evaluating the therapeutic effect of cerebral palsy in children. Methods 148 cases of spastic cerebral palsy children were divided into treatment group (83 cases) and control group (65 cases), and another 30 cases of normal children with exercise-induced non-cerebral palsy were selected as normal group. Treatment group self-rehabilitation training supplemented by spasm intramuscular injection of BTX-A, the control group rehabilitation by rehabilitation physicians, two groups of children with motor evaluation scale (physician rating scale, PRS) scores and the required medical costs changes. The gait analysis test platform was used to evaluate the curative effect of 30 randomly selected children from the treatment group before treatment and one month after treatment and compared with the normal group. Results The costs of the two methods were significantly lower in the treatment group than in the control group (P <0.000). After 3 months and 6 months of treatment, the PRS score of the treatment group was significantly better than that of the control group (P <0.000) The results of analyzer showed that after 1 month of treatment, the improvement of knee and ankle movement angle and pace of the treatment group was significantly better than that before treatment (P <0.05), and there was no significant difference between the treatment group and the normal group. Conclusion Rehabilitation combined with local injection of BTX-A is more effective than simple rehabilitation. The cost is lower than that of professional rehabilitation. It is simple and easy to implement. The gait analyzer is used to evaluate the curative effect with strong objectivity and reliable results.