葛政卿,何霏,余波,等.肉毒毒素注射后延迟系列石膏固定治疗痉挛型脑瘫伴马蹄足患儿的疗效观察[J].中华物理医学与康复杂志,2020,42(4):307-311
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| 肉毒毒素注射后延迟系列石膏固定治疗痉挛型脑瘫伴马蹄足患儿的疗效观察 |
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| DOI：10.3760/cma.j.issn.0254-1424.2020.04.004 |
| 中文关键词: 痉挛型脑瘫 马蹄足 A型肉毒毒素 系列石膏 |
| 英文关键词: Spasticity Cerebral palsy Equinus Botulinum toxin type A Series casting |
| 基金项目:上海市残联鼓励项目；上海市卫计委重要薄弱学科建设项目（2015ZB0401）；上海市申康医院发展中心市级医院新兴前沿技术联合攻关项目(SHDC12015130) |
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| 中文摘要: |
| 目的 对比观察肉毒毒素注射后不同时间介入系列石膏固定治疗痉挛型脑瘫伴马蹄足患儿的疗效。 方法 采用随机数字表法将63例痉挛型脑瘫伴马蹄足患儿分为观察组及对照组。2组患儿均给予基础康复治疗（包括足跟步行、踢球训练、单脚站立、立位平台上下训练、平衡训练等），观察组同时于小腿三头肌注射A型肉毒毒素2周后行系列石膏固定治疗，对照组则于A型肉毒毒素注射后即刻介入系列石膏固定治疗。2组患儿均石膏固定4周。于治疗前、治疗后2个月、6个月时分别运用改良Tardieu量表（MTS）、三维步态分析、粗大运动功能测试量表（GMFM-88）及自制问卷对患儿肌张力、步态、运动功能及护理情况进行评测。 结果 治疗后2个月、6个月时2组患儿MTS评分（伸、屈膝时踝跖屈肌R1,R2及R1-R2差值）、三维步态首触地时踝关节角度、支撑期和摆动期最大踝关节背屈角度、GMFM-88量表D区（站立）评分均较治疗前明显改善（P＜0.05）。治疗后2个月时观察组MTS评分(伸、屈膝时踝跖屈肌R1，R2及R1-R2差值)、支撑期最大踝关节角度［（8.57±7.38）°］、GMFM-88量表D区评分［（88.79±21.19）分］及治疗后6个月时MTS评分［伸、屈膝时踝跖屈肌R1，R2及R1-R2差值］、支撑期最大踝关节角度［（5.53±9.16）°］、GMFM-88量表D区评分［（83.52±20.64）分］均较对照组显著改善（P<0.05）。治疗后2个月、6个月时观察组首触地踝关节角度、摆动期最大踝关节背屈角度、步长、步速、GMFM-88量表E区评分与对照组间差异仍无统计学意义（P＞0.05）。 结论 肉毒毒素注射后延迟2周介入系列石膏固定较注射后即刻行石膏固定能更有效缓解痉挛型脑瘫患儿踝跖屈肌张力及痉挛状态，改善踝关节活动范围与功能，减轻系列石膏固定引起的不适与疼痛。 |
| 英文摘要: |
| Objective To compare the efficacy of series casting with different timings after botulinum toxin injection among equinus children with spastic cerebral palsy. Methods Sixty-three equinus children with spastic cerebral palsy were randomly divided into a control group and an experimental group. After being injected with botulinum toxin type A, 4 weeks of series casting was applied immediately in the control group, while in the experimental group it was applied 2 weeks later. Both groups were given basic rehabilitation therapy including heel walking, kicking balls, single-leg standing, standing platform training and balance training. The modified Tardieu scale, three-dimensional gait analysis, gross motor function measure 88 (GMFM-88) and a self-made questionnaire were used to evaluate muscle tone, spasticity, gait parameters, standing and walking before the treatment and 2 and 6 months afterward. Results Immediately after the treatment there was a significant improvement in both groups′ average MTS scores (R1, R2, R1-R2 with knee extension and flexion), dorsiflexion at initial contact, peak dorsiflexion in the stance and swing phases, and dimension D (standing), and also in their average GMFM-88 (walking) scores. Two and six months later the experimental group′s average MTS scores, peak dorsiflexion in the stance phase, and dimension D (standing) score in the GMFM-88 (walking) had improved significantly compared with the control group′s averages. However, no significant differences were observed between the two groups in any of the other measurements after the treatment. Conclusion Delaying series casting after botulinum toxin A injection can significantly reduce tone and spasticity in the plantarflexors, improve the range of motion and functioning of the ankle, and alleviate the discomfort and pain caused by series casting. |
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