安爽,马彩云,李靖婕,等.不同剂量A型肉毒毒素注射对儿童腓肠肌肌肉痉挛的影响[J].中华物理医学与康复杂志,2026,48(3):244-248
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| 不同剂量A型肉毒毒素注射对儿童腓肠肌肌肉痉挛的影响 |
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| DOI：10.3760/cma.j.cn421666-20250511-00402 |
| 中文关键词: 痉挛 肉毒毒素 剂量 肌肉形态 |
| 英文关键词: Spasm Botulinum toxin Dosage Muscle morphology |
| 基金项目:河南省医学科技攻关计划联合共建项目（LHGJ20220715） |
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| 中文摘要: |
| 目的 探讨不同剂量 A 型肉毒毒素（BoNT-A）注射对儿童腓肠肌痉挛的影响。方法 募集上运动神经元损伤致腓肠肌痉挛患儿 120 例，按随机数字表法分为常规康复组 40 例、小剂量注射组 39 例和大剂量注射组 41 例。3 组患儿均接受 3 周为 1 个疗程，共 4 个疗程的综合康复治疗，小剂量注射组和大剂量注射组在此基础上分别给予超声引导下 3U/kg 体重和 5U/kg 体重的 BoNT-A 腓肠肌注射。于治疗前和治疗 1、3、6 个月后分别对 3 组患儿进行痉挛量表（CSS）评分，同时测量其羽状角度数、肌肉厚度和肌肉硬度（杨氏模量），同时记录其不良反应发生情况。结果 治疗 1、3、6 个月后，3 组患儿 CSS 评分、羽状角度数、肌肉厚度和杨氏模量与组内治疗前比较差异均有统计学意义（P<0.05）；治疗 1、3、6 个月后，3 组患儿的羽状角度数、肌肉厚度和杨氏模量同时间点组间比较差异均有统计学意义（P<0.05），且小剂量注射组和大剂量注射组的 CSS 评分均显著低于常规康复组同时间点（P<0.05）；治疗 6 个月后，3 组患儿的不良反应发生率组间比较差异均无统计学意义（P>0.05）。结论 不同剂量的 BoNT-A 注射均可显著改善儿童腓肠肌痉挛的痉挛程度，且安全性相当，其中以小剂量的 BoNT-A 注射对儿童腓肠肌肌肉形态的影响更小，更推荐临床应用。 |
| 英文摘要: |
| Objective To quantify any effect of botulinum toxin type A (BoNT-A) dosage on gastrocnemius spasm in children. Methods A total of 120 children with gastrocnemius spasm caused by upper motor neuron injury were enrolled and randomly divided into a conventional rehabilitation group (40 cases), a low-dose injection group (39 cases) and a high-dose injection group (41 cases). All received 4 courses of comprehensive rehabilitation treatment, with each course lasting 3 weeks. The low- and high-dose injection groups were given ultrasound-guided BoNT-A injections into the gastrocnemius muscle of 3U/kg body weight or 5U/kg body weight, respectively. The children's Composite Spasticity Scale (CSS) scores were evaluated before the experiment and 1, 3 and 6 months afterward. Pennation angle, muscle thickness and muscle hardness (Young's modulus) were measured, and any adverse reactions were recorded. Results At 1, 3 and 6 months, the average CSS scores, pennation angles, muscle thicknesses and Young's moduli of the three groups differed significantly from before the treatment and between the groups. The average CSS scores of the low- and high-dose injection groups were significantly lower than the conventional rehabilitation group's averages at all three time points. At 6 months, there was no significant difference in the incidence of adverse reactions among the three groups. Conclusions BoNT-A injection can significantly relieve gastrocnemius spasm in children safely. Low dosage can be recommended, as it has less impact on the morphology of a child's gastrocnemius muscle. |
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