周陶成，童光磊，张敏，李司南，易昕，陈露露，温祖芳，康倩倩，陈婧.踝足矫形器联合肉毒毒素治疗痉挛型脑性瘫痪儿童尖足畸形的疗效观察[J].中华物理医学与康复杂志,2015,(10):761-764
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| 踝足矫形器联合肉毒毒素治疗痉挛型脑性瘫痪儿童尖足畸形的疗效观察 |
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| DOI： |
| 中文关键词: 脑性瘫痪 A型肉毒毒素 踝足矫形器 痉挛 |
| 英文关键词: Cerebral palsy Botulinum toxin A Ankle-foot orthosis Spasticity |
| 基金项目:安徽省卫生厅课题（2008B074）；安徽省卫生厅中医药管理局课题（2012zy63） |
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| 中文摘要: |
| 目的观察踝足矫形器（AFO）联合A型肉毒毒素（BTX-A）肌肉注射治疗痉挛型脑瘫患儿尖足的疗效。 方法痉挛型脑瘫患儿尖足畸形50例，采用随机数字表法将其分为对照组和观察组，每组25例，对照组患儿采用BTX-A肌肉注射与运动康复训练，观察组在对照组基础上加用AFO训练，与其运动康复训练同步。分别于治疗前、治疗后1、3和6个月，使用量角器测量踝关节的被动背屈角（APROM），改良Ashworth量表的评分（MAS）以及粗大运动功能量表（GMFM-88）的D区（站立）和E区（走跑跳）评分。 结果治疗前，观察组APROM、MAS和GMFM（D、E）分别为（109.25±12.38）°、（3.12±0.56）分和（55.32±11.23）分，与对照组［（107.11±13.44）°、（3.05±0.66）分和（56.21±10.81）分］比较，差异均无统计学意义（P>0.05）。2组患儿的APROM、MAS和GMFM评分在治疗后1、3和6个月时与组内与治疗前比较，差异均有统计学意义（P<0.05）；治疗后，观察组APROM、MAS和GMFM评分分别与对照组治疗比较，差异亦均有统计学意义（P<0.05）。2组治疗后各时间点之间的评估指标比较，观察组差异均有统计学意义；对照组治疗后1个月与治疗后3个月比较，差异有统计学意义（P<0.05），治疗后3个月和治疗后6个月比较，差异无统计学意义（P>0.05）。 结论AFO联合BTX-A疗法能进一步缓解痉挛型脑瘫患儿的下肢痉挛程度，减轻尖足异常姿势，维持时间更持久。 |
| 英文摘要: |
| Objective To observe the clinical efficacy of ankle-foot orthosis (AFO) combined with botulinum toxin type A (BTX-A) injection in treating tip foot deformity in children with cerebral palsy (CP). MethodsFifty CP children with tip foot deformity were selected and randomly divided into a control group and an observation group according to a random number table. Both groups were given BTX-A injection, and the observation group was additionally treated with AFO. All children were assessed before, 1 month, 3 months and 6 months after the treatment using the modified Ashworth scale (MAS), passive ankle range of movement (APROM0 and gross motor function measurement scale-88 (GMFM-88) D area (standing) and E area (walking, running and jumping). ResultsBefore the treatment, there were not significant differences between the two groups in all measurements (P>0.05). At 1 month, 3 months and 6 months after the treatment, significant differences were observed in all values for both groups compared to before the treatment (P<0.05). There was significant difference between two groups at all the same time points after treatment with regard to all the assessment parameters (P<0.05). In the control group, significant differences were found in all measurements after 1 and 3 months′ treatment, but not found after 3 and 6 months′ treatment. ConclusionAFO combined with BTX-A) injection can further relieve lower limb spasticity and reduce tip foot abnormal posture with longer duration. |
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