任雪松,蔡志军,张小安,等.全身振动训练联合肉毒毒素注射对痉挛型双瘫脑瘫儿童尖足及粗大运动功能的影响[J].中华物理医学与康复杂志,2019,41(9):688-692
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| 全身振动训练联合肉毒毒素注射对痉挛型双瘫脑瘫儿童尖足及粗大运动功能的影响 |
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| DOI：DOI:10.3760/cma.j.issn.0254-1424.2019.09.012 |
| 中文关键词: 脑性瘫痪 全身振动训练 A型肉毒毒素 尖足 粗大运动功能 |
| 英文关键词: Cerebral palsy Whole body vibration Botulinum neurotoxin A Tipped foot Gross motor function |
| 基金项目:国家自然科学基金资助项目（No.81870983）；河南省医学科技攻关省部共建项目（SBGJ2018047） |
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| 中文摘要: |
| 目的 观察全身振动训练联合A型肉毒毒素注射对痉挛型双瘫脑瘫儿童尖足及粗大运动功能的影响。 方法 选取2~5岁痉挛型双瘫脑瘫尖足患儿60例，按随机数字表法分为对照组和观察组，每组30例。对照组采用A型肉毒毒素注射腓肠肌内外侧头肌腹部，每个靶肌肉注射剂量为3 IU/kg，一次性注射完毕，注射后24 h给予常规康复治疗5个疗程，每个疗程3周，每周治疗5 d；观察组在对照组基础上加用全身振动训练，患儿采取站立位，每次振动时间为2 min，休息1 min，共3~4次为一组，每日一组，每周治疗5 d，疗程与常规康复治疗同步。分别于治疗前、治疗后1个月、3个月、6个月，采用改良Tardieu量表评分（MTS）评价小腿三头肌痉挛情况；采用肌肉快速牵张时出现卡住的角度（快角，记录为R1）和肌肉慢速活动下关节全范围活动度（慢角，记录为R2）评价踝关节活动度；采用粗大运动功能量表（GMFM-88）D区（站立功能）、E区（走跑跳功能）评分评价运动功能。对2组患者治疗前后的上述观察指标进行统计学分析比较。 结果 治疗前，2组患儿MTS评分［观察组（3.60±0.56）分；对照组（3.57±0.63）分］、R1［观察组（-8.27±7.98）°；对照组（-9.30±7.01）°］、R2［观察组（7.43±7.75）°；对照组（7.20±7.55）°］、GMFM-88评分［观察组（35.10±7.07）分；对照组（36.63±7.46）分］组间差异均无统计学意义（P>0.05）。治疗后1个月、3个月和6个月，2组患儿MTS评分［观察组（2.43±0.68）、(1.83±0.46)和(2.17±0.75）分；对照组（2.83±0.79）、（2.33±0.61）和（2.70±0.75）分］均小于组内治疗前，R1［观察组（4.17±6.20）°、（9.87±5.47）°和（4.90±7.04）°；对照组（0.27±7.16）°、（3.73±7.49）°和（-1.73±7.32）°］、R2［观察组（18.07±6.15）°、（24.47±5.85）°和（19.30±5.98）°；对照组（15.07±6.55）°、（19.10±7.80）°和（14.03±7.13）°］、GMFM-88评分［观察组（49.20±7.38）、（58.47±7.17）和（64.37±7.11）分；对照组（45.10±8.75）、（51.73±8.41）和（56.83±8.44）分］均大于组内治疗前，差异均有统计学意义（P<0.05）。治疗后1个月、3个月和6个月同时间点比较，观察组的MTS评分均小于对照组，R1、R2均大于对照组，差异均有统计学意义（P<0.05）。2组患儿治疗后1个月的GMFM-88评分组间差异无统计学意义（P>0.05）；治疗后3个月和6个月同时间点比较，观察组GMFM-88评分均大于对照组，差异均有统计学意义（P<0.05）。 结论 全身振动训练联合A型肉毒毒素注射能有效改善痉挛型双瘫脑瘫儿童尖足及粗大运动功能。 |
| 英文摘要: |
| Objective To observe the effect of combining whole body vibration with botulinum neurotoxin A injections on tiptoe and the gross motor function of children with spastic diplegic cerebral palsy. Methods Sixty spastic diplegic children with tipped foot aged between 2 to 5 were equally divided into a control group and an experimental group randomly. The control group received 3 IU/kg botulinum neurotoxin A injections to the medial and lateral heads of the gastrocnemius muscle. Then 5 daily courses of conventional training were administered 5 days a week for 3 weeks beginning 24 hours after the injections. The experimental group additionally received 2min of whole body vibration 3 or 4 times per day with one-minute rests, 5 days per week for 5 weeks. All of the children were assessed before the experiment and 1, 3 and 6 months later using the modified Tardieu scale (MTS) and the R1 and R2 ankle and dimensions D and E of the gross motor function measurement scale (GMFM-88). Results There were no significant differences between the two groups before the treatment. Afterward, the average MTS, R1, R2 and GMFM-88 scores of both groups were significantly improved. The average MTS, R1 and R2 scores of the experimental group after treatment were significantly better than the control group′s averages. The average GMFM-88 score of the experimental group was not significantly different from that of the control group after 1 month, but after 3 and 6 months significant differences emerged. Conclusion Whole body vibration improves the effectiveness of botulinum neurotoxin A injections in relieving tiptoe and improving the gross motor function of children with spastic diplegic cerebral palsy. |
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