【摘要】 目的:探讨非肌电引导下A型肉毒毒素注射治疗儿童痉挛型脑瘫的疗效。方法:选择68例双下肢痉挛型脑瘫患儿,采用“反向牵拉指压法”进行非肌电引导下定点后多点注射治疗,注射后次日开始进行痉挛肌牵伸及功能训练,注射后1周配戴AFO或KAFO,并强化康复训练。注射前及注射后3天、1周、1个月、2个月、3个月听取父母的报告,观察内收肌角、直腿抬高角、腘窝角、踝背伸角,痉挛肌改良Ashworth分级及粗大运动评分的变化。结果:①父母的报告:起效时间为注射后6—72h,到达高峰时间为1—2周,疗效维持>3月,有少数患儿1—2个月后疗效开始减弱。痉挛严重,注射剂量>24U/kg体重的10例患儿,于注射后24h出现无力、食欲减退等副反应,并在3周至1个月消失;②内收肌角、直腿抬高角、腘窝角、踝背伸角自注射后3天开始显著增大(P<0.05),1个月时达高峰(P<0.001),至3个月后又有变小,但并未回复到注射前;③痉挛肌改良Ashworth分级与关节活动度的变化规律一致;④粗大运动评分(GMFM-66)1个月后显著改善(P<0.05),并在随后的观察中持续性改善;⑤疗效及副反应与剂量呈显著相关。结论:A型肉毒毒素注射配合矫形器及康复训练,能有效改善痉挛性脑瘫患儿的运动功能,非肌电引导的徒手定位注射技术经济、便捷、有效,多点注射技术有可能减少由于高剂量带来的远处副作用及非靶肌的扩散。更多还原

【Abstract】 Objective:To evaluate the therapeutic effect of injections of Botulinum toxin A without direction of electromyography in the treatment of children with spastic cerebral palsy.Method:Sixty-eight children with cerebral palsy that had lower limb spasticity, were injected with botulinum toxin A at several muscular sites without the use of electromyography. The injection sites were located by Reverse Stretching and Palpation. After injection, the children underwent stretching of the spastic muscle involved and started functional training on the next day. They were supported by an AFO or a KAFO for one week and commenced reforeing functional training for 3 months after the injection. Result:①The parents reported that Botulinum toxin A came into effect at 6-72 hours after injection, peaked 1-2 weeks later and the effect persisted for more than 3 months. For a few children, the effects only lasted 1-2 months post-injection. The main side effects such as appetite decrease and weakness, were observed in children with serious spasm that required injections with large doses of Botulinum Toxin A. These side effects were not present after 3 weeks to 1 month post-injection.②The adductor angle, the hip flexor angle, the popliteal angle and the angle of ankle dorsi-flexion were significantly improved 3 days after injection(P<0.05) and peaked at 1 month(P<0.001). The effect decreased 2-3 months after injection, but the children were still significantly improved compared with the parameters measured pre-injection(P<0.05).③The changes showed on the Modified Ashworth Scale (MAS) of the spastic muscle were consistent with the improvement seen with the other measures of ROM. ④The GMFM-66 increased significantly 1 month post-injection(P<0.05) and this change was observed to persist for a few months. ⑤The dosage was significantly correlated with the onset of side effects.Conclusion:Botulinum toxin A in conjunction with orthotics and rehabilitation training effectively improved the movement functions of children with spastic cerebral palsy. The non-electromyography location and injection technique is money saving, convenient and effective.更多还原