A型肉毒毒素注射治疗9~36月龄脑瘫患儿腓肠肌痉挛的前瞻性研究

Effect of botulinum toxin A injection in the treatment of gastrocnemius spasticity in children aged 9-36 months with cerebral palsy: a prospective study

摘要:

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(sEMG)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sEMG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。

Abstract:

Objective To investigate the long-term clinical efficacy and adverse effects of botulinum toxin-A(BTX-A) injection in the treatment of gastrocnemius spasticity in children aged 9-36 months with cerebral palsy.Methods Eighty children aged 9-36 months with cerebral palsy and gastrocnemius spasticity were selected and randomly divided into a BTX-A injection group and a conventional treatment group(n=40 each).The children in the BTX-A injection group received injections of BTX-A guided by color Doppler ultrasound and 4 courses of rehabilitation training after injection.Those in the conventional treatment group received 4 courses of the same rehabilitation training alone.Before treatment and at 1, 2, 3, and 6 months after treatment, the modified Tardieu scale(MTS) was applied to assess the degree of gastrocnemius spasticity, the values in the passive state measured by surface electromyography(sEMG) were applied to evaluate muscle tension, and the Gross Motor Function Measure(GMFM) was used to evaluate gross motor function.Results Compared with the conventional treatment group, the BTX-A injection group had significantly greater reductions in MTS score and the values in the passive state measured by sEMG(P<0.05), as well as significantly greater increases in joint angles R1 and R2 in MTS and gross motor score in GMFM(P<0.05).No serious adverse reactions related to BTX-A injection were found.Conclusions BTX-A injection is effective and safe in the treatment of gastrocnemius spasticity in children aged 9-36 months with cerebral palsy.