不同剂量A型肉毒毒素注射缓解脑性瘫痪患儿腘绳肌痉挛的前瞻性研究

关键词：A型肉毒毒素  脑性瘫痪  腘绳肌  痉挛

Keywords:Botulinum toxin Type A  cerebral palsy  hamstring  spasm

摘要：

      摘要 目的：观察常规康复治疗与不同剂量A型肉毒毒素（BTX-A）注射缓解痉挛型脑瘫患儿腘绳肌痉挛的临床疗效、肌肉形态改变及不良反应。 方法：按随机数字表法分组，最终纳入78例腘绳肌痉挛脑瘫患儿。常规康复组为A组，21例；BTX-A注射组为B、C、D组，分别为19、18、20例，注射剂量分别为3U/kg、4U/kg、5U/kg。治疗前后1、3、6、12个月，采用改良Ashworth 痉挛分级量表（MAS）、表面肌电图被动状态积分肌电值（iEMG）评定腘绳肌的痉挛程度；彩色多普勒超声仪测量腘绳肌的肌肉形态；粗大运动评定量表（GMFM）评定运动功能。 结果：在MAS分级、iEMG数值方面，BTX-A 注射组治疗后各时间点低于常规康复组（P<0.05），不同剂量组之间无显著性意义（P>0.05）；在GMFM评分方面，BTX-A 注射组与常规康复组在各时间点之间差异有显著性意义（P<0.05）；在肌肉形态方面，不同剂量组与常规康复组治疗后各时间点半腱肌的横截面积及肌纤维长度无差异（P>0.05）。不同剂量组治疗后均无明显不良反应。 结论：BTX-A注射组缓解脑瘫患儿腘绳肌痉挛优于常规康复组且未影响肌肉发育，不同注射剂量在临床疗效、肌肉形态改变和不良反应上均无显著差异。

Abstract:

      Abstract Objective: To observe the clinical efficacy, muscle morphological changes and adverse reactions after routine rehabilitation therapy and different doses of botulinum toxin type A (BTX-A) injection in the treatment of hamstring spasm in children with spastic cerebral palsy. Method: According to the random numerical table method, 78 cases of cerebral palsy with the popliteal spasm were finally included. The routine rehabilitation group was group A,21 cases. The BTX-A injection groups were group B, C and D. The corresponding cases were 19, 18 and 20. The corresponding doses were 3U/kg, 4U/kg, and 5U/kg. Before treatment and 1,2,3,6 and 12 months after treatment, modified Ashworth spasm rating scale (MAS) and table facial electromyography passive state integral electromyography (iEMG) were used to assess the spasm of the hamstring muscle, the muscle shape of the hamstring muscle was measured by color doppler ultrasonography, and the gross motion rating scale (GMFM) was used to evaluate motor function. Result: Compared with the conventional treatment group, the BTX-A injection groups had significantly greater reductions in MAS score and iEMG value at each point in time (P<0.05), and there was no statistical significance among the different dosage groups (P>0.05). In terms of GMFM score, there were statistically significant differences between BTX-A injection group and routine rehabilitation group at each point in time(P<0.05). In terms of muscle morphology, there were no significant difference among different dose groups and conventional rehabilitation group in the cross-sectional area of the tendon and the length of muscle fiber (P>0.05). No serious adverse reactions related to BTX-A injection were found. Conclusion: BTX-A injection was superior to conventional rehabilitation group in alleviating hamstring spasm in children with spastic cerebral palsy and didn’t affect muscle development. There was no significant difference on clinical efficacy, muscle morphological change and adverse reaction at each time point among the different doses of BTX-A injection.