A型肉毒毒素注射联合功能训练对痉挛型脑瘫患儿尖足畸形、粗大运动功能及智力发育的影响研究

发布时间：2018-05-30 00:11

本文选题：脑性瘫痪 + 肉毒杆菌毒素类　；参考：《中国全科医学》2017年31期

【摘要】：目的探讨A型肉毒毒素(BTX-A)注射联合功能训练对痉挛型脑瘫(SCP)患儿尖足畸形、粗大运动功能及智力发育的影响。方法选取2012年4月—2015年10月河南省中医院收治的SCP患儿66例。按照随机数字表法将患者分为对照组(n=33)和观察组(n=33)。对照组予以功能训练,包括被动关节活动度训练、肌力训练、步行训练;观察组在对照组的基础上接受BTX-A注射治疗。于治疗前和治疗后3个月,观察和比较两组患儿的下肢痉挛程度、踝关节被动背屈角度、粗大运动功能发育情况、智力发育水平、日常生活活动能力(ADL),并观察治疗过程中的不良反应。结果 (1)下肢痉挛程度:两组治疗前后综合痉挛量表(CSS)评分差值比较,差异有统计学意义(t=4.388,P0.01)。(2)踝关节被动背屈角度:两组治疗前后左足背屈角度、右足背屈角度差值比较,差异均有统计学意义(t值分别为3.937、3.060,P0.01)。(3)粗大运动功能发育情况:两组治疗前后粗大运动功能量表(GMFM)的D、E区评分差值比较,差异均有统计学意义(t值分别为17.207、7.559,P0.01)。(4)智力发育水平:两组治疗前后婴幼儿智力发育量表(CDCC)的智力发育指数(MDI)和心理运动发育指数(PDI)差值比较,差异均无统计学意义(t值分别为1.733、1.746,P0.05)。(5)ADL评分:两组治疗前后ADL评分差值比较,差异有统计学意义(t=6.792,P0.01)。(6)不良反应:两组患者均未发生明显的不良反应。结论 BTX-A注射联合功能训练能有效改善SCP患儿尖足畸形和粗大运动功能,不会对智力发育产生影响,并能提高患儿ADL。
[Abstract]:Objective to investigate the effects of botulinum toxin A (BTX-A) injection combined with functional training on apical foot deformity, coarse motor function and intellectual development in children with spastic cerebral palsy (SCP). Methods 66 cases of SCP were selected from April 2012 to October 2015 in Henan traditional Chinese Medicine Hospital. Patients were divided into control group and observation group according to random number table. The control group received functional training, including passive joint movement training, muscle strength training and walking training, while the observation group received BTX-A injection therapy on the basis of the control group. Before and 3 months after treatment, the degree of spasm of lower extremity, the angle of passive dorsiflexion of ankle joint, the development of coarse motor function and the level of intellectual development were observed and compared between the two groups. ADL activity and adverse reactions during treatment were observed. Results (1) the degree of spasticity of lower extremity: the difference of CSS score before and after treatment was statistically significant (P < 0.05). The angle of passive dorsiflexion of ankle joint: the angle of left foot flexion and the angle difference of right foot flexion before and after treatment were compared between the two groups. There were significant differences in the development of gross motor function between the two groups (3.937 / 3.060,3.060). The difference of the DNE score between the two groups before and after treatment was compared, and the difference between the two groups before and after treatment was analyzed. The difference was statistically significant (P < 0.01). The difference of mental development index (MDI) and psychomotor development index (PDI) between the two groups were compared before and after treatment. There was no significant difference between the two groups. The difference of ADL scores before and after treatment was statistically significant. There were no significant adverse reactions between the two groups. There were no significant adverse reactions in the two groups. Conclusion BTX-A injection combined with functional training can effectively improve the apical foot deformity and coarse motor function of SCP children, and can not affect the intelligence development, and can improve the ADL of children with SCP.
【作者单位】：河南省中医院儿童脑病康复科;
【基金】：河南省高等学校重点科研计划项目(15A360003)
【分类号】：R742.3

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