A型肉毒毒素治疗对脑卒中患者踝阵挛及步行功能的影响

关键词：A型肉毒毒素  脑卒中  踝阵挛  步行功能

Keywords:botulinum toxin type A  stroke  ankle clonus  ambulation

摘要：

      摘要 目的：观察超声引导下A型肉毒毒素治疗对脑卒中患者踝阵挛及下肢功能运动功能的疗效。 方法：43例脑卒中患者随机分为治疗组(n=22)和对照组(n=21)。两组常规治疗相同，治疗组在超声引导下将A型肉毒毒素400U注射入腓肠肌、比目鱼肌及胫后肌；对照组给予巴氯芬30mg/d治疗。两组患者分别于治疗前和治疗2周后采用踝阵挛分级法、Biodex步行测试仪分别对患者进行评估。 结果：两组患者一般资料差异无显著性意义。治疗前两组患者的踝阵挛分级、步速、健侧步长、患侧步长、健侧/患侧步长比、健侧步行所占时间比和患侧步行所占比差异无显著性意义。与对照组相比，治疗2周后，治疗组患者的踝阵挛分级、步速、健侧步长、患侧步长、健侧/患侧步长比、健侧步行所占时间比和患侧步行所占比分别为均有改善，差异均有显著性意义（P＜0.05）。 结论：与口服巴氯芬相比，短期内，A型肉毒毒素能更好地减轻踝阵挛，提高步速，改善患者步行质量。

Abstract:

      Abstract Objective: To evaluate the effect of botulinum toxin A on ankle clonus and mobility of the lower extremity in subjects with stroke. Method: In a randomized controlled trial, 43 subjects with stroke were randomly assigned into 2 groups: treatment group(n=22) and control group(n=21). The regular treatments applied to both of the two groups were the same. The treatment group were treated with 400 units (U) of botulinum toxin type A injection into the gastrocnemius, soleus and posterior tibial muscle with the guidance of ultrasound, while the control group were treated with baclofen 10mg tid. Measurements including the clonus score of ankle, gait speed, stride length of both lower extremities, the ratio of stride length of the non paretic extremity to the paretic extremity, and percentage of stride duration of each lower extremity were recorded before injection and 2 weeks after. Result: Before treatment, there were no significant differences between the two groups for general data and the baseline of measurements. After two weeks treatment, the clonus score of ankle, gait speed, stride length of both lower extremities, the ratio of stride length of the non paretic extremity to the paretic extremity, and percentage of stride duration of the paretic extremity of the treatment group were improved. The differences of each measurements between the two groups were significant(P<0.05). Conclusion: Compared to baclofen, Botulinum toxin A could relieve ankle clonus after a short period, so as to improve the gait speed and quality in stroke patients.