A型肉毒毒素联合冲击波疗法对脑卒中后下肢痉挛状态的疗效观察

发布时间：2018-05-30 13:43

本文选题：脑卒中 + 痉挛状态　；参考：《中国康复医学杂志》2017年07期

【摘要】：目的:观察A型肉毒毒素(BTX-A)注射联合体外冲击波疗法(ESWT)对脑卒中后下肢肌肉痉挛状态的疗效和安全性。方法:共选取60例脑卒中患者,均伴有下肢肌肉痉挛(小腿三头肌痉挛为主),随机分为常规治疗组、常规治疗+BTXA治疗组、常规治疗+BTX-A+ESWT治疗组,每组各20例患者。常规治疗组(A组)采用各种常规康复训练方法,每日1次,每周6次,共治疗4周;常规治疗+BTX-A组(B组)的患者除了进行常规康复治疗外,还对小腿痉挛肌肉进行BTX-A注射;而常规治疗+BTX-A+ESWT组(C组)除了进行常规康复治疗及局部注射BTX-A外,还给予患者小腿三头肌进行EWST治疗,每周1次,治疗4周。治疗前和治疗后1周、4周和16周分别进行踝关节跖屈肌群肌张力、下肢运动功能以及日常生活活动(ADL)能力评定。结果:(1)肌张力变化情况:三组患者治疗1周后,与治疗前相比,A组和B组略有下降、但是C组肌张力显著性降低(P0.05)。4周后,A、B、C组肌张力均显著性下降(P0.05),而B组、C组较A组效果更为佳(P0.05)。16周随访,A、B、C组肌张力均有所回升,但B、C组肌张力较治疗前仍降低(P0.05),且C组优于B组(P0.05)。(2)运动及ADL能力变化情况:三组患者治疗1周后,A、B、C组患者的运动功能及ADL能力无明显改善;4周后,三组运动功能和ADL能力均有所改善(P0.05),B组、C组改善较A组更好(P0.05)。而16周时,A组、B组运动功能和ADL能力出现下降,B组、C组相比虽有下降,但仍优于A组(P0.05)。结论:A型肉毒毒素联合冲击波疗法可以迅速并且较持久地降低患者肌张力,也能够有效地提高患者的运动功能和ADL能力,对脑卒中后肢体痉挛有明显改善作用。
[Abstract]:Aim: to observe the efficacy and safety of botulinum toxin A (BTX-A) injection combined with extracorporeal shock wave therapy (ESWT) in the treatment of lower extremity muscle spasm after stroke. Methods: sixty patients with cerebral apoplexy were randomly divided into conventional treatment group (BTXA group) and routine BTX-A ESWT group (20 cases in each group). Group A (group A) were treated with routine rehabilitation training once a day, 6 times a week for 4 weeks, and group B (group B) received BTX-A injection in addition to routine rehabilitation. In addition to routine rehabilitation and local injection of BTX-A, the patients were treated with EWST once a week for 4 weeks. The muscle tension of metatarsal flexor muscle group, motor function of lower extremity and ADL ability were evaluated before treatment and 1 week and 16 weeks after treatment, respectively. Results the changes of muscle tension: after one week of treatment, the patients in group A and group B decreased slightly compared with those before treatment. But the muscle tension in group C was significantly lower than that in group A (P 0.05) 4 weeks later, and that in group C was significantly lower than that in group A (P 0.05), and that in group B was better than that in group A (P 0.05). 16 weeks follow-up showed that the muscle tension in group A was higher than that in group A (P 0.05), and that in group C was higher than that in group A (P < 0.05). But the muscle tension of group C was lower than that before treatment, and group C was superior to group B (P 0.05) and the change of ADL ability: the motor function and the ability of ADL in group C were not significantly improved after 1 week of treatment. Motor function and ADL ability were improved in all three groups. Group C was better than group A in improving motor function and ADL ability. At 16 weeks, the motor function and ADL ability of group A and group B decreased, but it was better than group A (P 0.05), although it was lower than group C (group B). Conclusion the combination of botulinum toxin type A and shock wave therapy can reduce muscle tension rapidly and persistently, improve motor function and ADL ability of patients, and improve limb spasm after stroke.
【作者单位】：第四军医大学附属西京医院;
【基金】：国家科技部国际合作项目(2013DFA32610) 国家自然科学基金项目(81271450) 陕西省国际合作与交流项目(2015KW-035)
【分类号】：R743.3

【参考文献】