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目的探讨A型肉毒毒素(BTX-A)注射对9~36月龄脑瘫患儿下肢腓肠肌痉挛的长期临床疗效及不良反应。方法选择9~36月龄腓肠肌痉挛脑瘫患儿80例,随机分为BTX-A注射组和常规治疗组,每组40例。BTX-A注射组在彩色多普勒超声仪引导下行BTX-A注射,注射后给予4疗程常规康复训练;常规治疗组仅给予4疗程相同常规康复训练。治疗前及治疗后1、2、3、6个月采用改良Tardieu量表(MTS)评定腓肠肌痉挛程度,采用表面肌电图(s EMG)被动状态数值评估肌张力,采用粗大运动功能测试(GMFM)评价粗大运动功能。结果在降低MTS评分和s EMG被动状态数值方面,BTX-A注射组优于常规治疗组(P<0.05);在增大MTS踝关节角度R1、R2和提高大运动GMFM评分方面,BTX-A注射组优于常规治疗组(P<0.05)。未见严重的BTX-A注射相关不良反应。结论 BTX-A注射治疗9~36月龄脑瘫患儿腓肠肌痉挛是有效和安全的。
Objective To investigate the long-term clinical efficacy and adverse reactions of botulinum toxin type A (BTX-A) injection on gastrocnemius muscle spasms in children with cerebral palsy aged 9-36 months. Methods Eighty children with cerebral palsy of gastrocnemius muscle spasm from 9 to 36 months old were randomly divided into BTX-A injection group and conventional treatment group, 40 cases in each group. The BTX-A injection group underwent BTX-A injection in a color Doppler ultrasound system and received 4 cycles of routine rehabilitation training after injection. The conventional treatment group received only 4 cycles of the same routine rehabilitation training. Before treatment and 1,2,3,6 months after treatment, gastrocnemius muscle spasm was assessed by modified Tardieu scale (MTS). Muscular tension was evaluated by surface EMG (passive EMG) state, and gross motor function test (GMFM ) Evaluate gross motor function. Results The BTX-A injection group was superior to the conventional treatment group (P <0.05) in reducing the MTS score and the passive state value of s EMG (P <0.05). In terms of increasing the MTS ankle angle R1, R2 and increasing the GMFM score of large movement, The injection group was better than the conventional treatment group (P <0.05). No serious BTX-A-related adverse events were noted. Conclusion BTX-A injection is effective and safe for gastrocnemius spasm in children with cerebral palsy aged 9-36 months.