A型肉毒毒素协同康复训练治疗脑卒中患者下肢肌痉挛的研究

关键词：Ａ型肉毒毒素  痉挛  康复治疗  脑卒中

Keywords:botulinum toxin type A  spasticity  rehabilitation therapy  stroke

摘要：

      目的：研究A型肉毒毒素治疗痉挛性下肢瘫痪的效果。方法： 将126例脑卒中患者随机分为治疗组和对照组，两组除予以常规治疗和康复训练外，治疗组对痉挛肌肉加用肉毒毒素A注射。用改良Ashworth痉挛量表（MAS）、Fugl-Meyer运动功能量表（FMA）、Berg平衡量表（BBS）和改良Barthel指数（MBI）于治疗前、治疗1个月、3个月和5个月后进行评价。结果：对照组在治疗3个月后，MAS、FMA、BBS和MBI等各项指标均较治疗前和治疗1个月后明显改善(P<0.05)，治疗5个月时情况与之相仿；治疗组在治疗1个月后，MAS评分明显下降（P<0.05），FMA、BBS和MBI评分均明显提高（P<0.05），3个月后，MAS评分有所反弹，但仍明显低于治疗前(P<0.05)；与对照组在治疗1个月及3个月后比较，MAS、BBS和MBI评分的差异均有显著性(P<0.05)；治疗5个月后，治疗组的MAS及FMA评分与对照组比较差异无显著性(P>0.05)，但此时BBS和MBI指标仍明显好于对照组(P<0.05)。结论：系统的康复训练能明显改善痉挛性下肢瘫痪的肌肉痉挛、步行能力、平衡能力和日常生活活动能力，协同局部肉毒毒素A注射其效果更加明显。

Abstract:

      Objective: To explore the effect of local injection of botulinum toxin type A(BTX-A) on patient′s lower extremities with spastic paralysis. Method: Total 126 cases of stroke survived patients were randomized divided into either control group(treated with conventional rehabilitation treatment) or treatment group（treated with treatment as control and extra local intramuscular injection of BTX-A). The modified Ashworth scale (MAS), Fugl-Meyer assessment scale(FMA) and Berg balance scale(BBS) as well as modified Barthel index(MBI) were used in evaluation at different time points: before treatment (t0) and 1month(t1), 3months(t2) and 5months(t3) after treatment. Result: For control group, at t2 and t3, the outcomes of MAS、FMA、BBS and MBI were significant better than those at both t0 and t1 time points(P<0.05), For treatment group, at t1, all scores of MAS、FMA、BBS and MBI were significant better than those at t0 time point(P<0.05). Although at t2, MAS could be bounced and higher, but it was still lower than that at t0(P<0.05）. Comparing with control group at t1 and t2, MAS, BBS and MBI assessments demonstrated much better results in treatment group(P<0.05). At t3, in two groups scores of MAS and FMA had no significant difference (P>0.05)，but both scores of BBS and MBI in treatment group still were higher than those in control group (P<0.05). Conclusion: This study indicated that the combination of BTX-A with rehabilitation training could be beneficial for stroke patients′ lower extremities with spastic paralysis, the outcomes of MAS、FMA、BBS and MBI were significant different from conventional rehabilitation treatment, the abilities of walking, balancing and ADL of patients improved.