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目的评价肌电引导和徒手肌肉定位在A型肉毒毒素(botulinum toxintypeA,BTX-A)治疗脑卒中肌痉挛的临床效果。方法选择因脑卒中致上下肢肌肉痉挛的患者36例,随机分为A组(肌电引导注射)和B组(徒手肌肉定位注射)各18例,两组均选择肱二头肌、股直肌、内收肌、腓肠肌、比目鱼肌、胫骨后肌等痉挛肌肉注射A型肉毒毒素200U,用改良Ashworth痉挛量表(MAS)、Fugl-Meyer运动功能量表(FMA)于治疗前、治疗1周、治疗6周、治疗3个月后进行评价。结果两组在治疗3个月后MAS和FMA指标均较治疗前有明显改善,肱二头肌、股直肌、内收肌等四肢表浅大肌群于徒手肌肉定位注射BTX-A优于腓肠肌、比目鱼肌、胫骨后肌等深层小肌肉(P<0.05),肌电引导深层小肌肉优于表浅大肌肉(P<0.05)。结论肌电引导注射BTX-A适用于深层小肌肉,徒手肌肉定位注射BTX-A适用于四肢表浅大肌肉,两者结合可达到最佳定位效果。
Objective To evaluate the clinical efficacy of myoelectricity-guided and manual muscular localization in the treatment of stroke muscle spasms by botulinum toxin type A (BTX-A). Methods Thirty-six patients with upper extremity muscle spasm due to stroke were randomly divided into group A (electromyography lead injection) and group B (hand muscle positioning injection), 18 in each group. Biceps brachii, Muscle, adductor muscle, gastrocnemius muscle, soleus muscle and tibialis posterior muscle were injected intramuscularly with botulinum toxin type A 200U before treatment with Modified Ashworth Spasm Scale (MAS) and Fugl-Meyer Motor Function Scale (FMA) 1 week, 6 weeks of treatment, 3 months after treatment for evaluation. Results Both MAS and FMA indexes improved significantly after 3 months of treatment in both groups. Biceps femoris, rectus femoris, adductor muscle and other superficial superficial muscles were superior to BTX-A Gastrocnemius muscle, soleus muscle and tibialis posterior muscle (P <0.05), and myoelectrical induction of deep small muscle was superior to superficial muscle (P <0.05). Conclusions MTX injection of BTX-A is suitable for the deep small muscle. BTX-A is applied to the superficial muscles of the extremities with bare hand muscle positioning. The combination of the two can achieve the best localization effect.