A型肉毒毒素治疗双下肢痉挛型脑性瘫痪疗效观察

目的探讨A型肉毒毒素（BTXA）加位点注射治疗双下肢痉挛型脑性瘫痪的疗效。方法治疗组分别用A型肉毒毒素和VitB1、VitB12对32例双下肢痉挛型脑瘫患儿进行位点注射。对照组A型肉毒毒素对32例双下肢痉挛型脑瘫患儿进行位点注射结果以下肢内收肌、腘窝角、足背屈角的改善程度评定显示，总有效率为95．3％．6个月疗效评定，治疗组有效率为98％，疗效显著。结论A型肉毒毒素加VitB1、VitB1：位点注射治疗双下肢痉挛型脑瘫是一种极为有效的治疗方法。     

痉挛型脑瘫儿童的药物和物理康复治疗及其疗效

目的　探讨A型肉毒毒素 (BTA)对痉挛型脑瘫儿童的临床治疗价值及物理治疗对其运动功能的影响。方法　选择 2 0例痉挛型脑瘫儿童采用BTA神经阻滞治疗肌痉挛 ,上肢肌群注射BTA的起始剂量为 1～ 2U/kg ,下肢肌群的BTA注射的起始剂量为 3～ 4U/kg。结合物理康复治疗 ,治疗前后进行Gross运动功能评分。结果　经BTA注射后的肌张力有明显降低 ,关节活动度有一定程度的提高 ,改善了患儿的运动功能 ,Gross运动功能评分 5个功能区治疗前后有显著性差异 (P <0 .0 5 )。结论　BTA对痉挛型脑瘫儿童肢体痉挛肌群进行神经阻滞注射及结合物理康复治疗 ,有缓解肌痉挛、改善站立和行走等运动功能的作用     

A型肉毒毒素治疗卒中患者痉挛性足下垂和足内翻的研究

目的探讨A型肉毒毒素治疗卒中后患者痉挛性足下垂及足内翻的效果及对步行功能的改善。方法35例卒中后痉挛性足下垂及足内翻患者,随机分为BTX2A注射结合物理治疗组(17例)和单纯物理治疗组(18例)。治疗组应用下肢肌肉局部注射国产A型肉毒毒素治疗,每个患者每次选择3~5块肌肉,每块肌肉总的注射剂量为50~100IU。对照组仅接受康复治疗。所有患者在注射前,注射后2周、1个月、3个月改良Ashworth量表(MAS)评定肌张力变化,按粗大运动功能量表(GMFM)中的D和E两项及步行速度评价步行能力。结果MAS评分治疗后2周、1个月、3个月组间差异均有统计学意义(P<0.05)。GMFM评分治疗后1、3个月组间差异均有统计学意义(P<0.05)。步行速度治疗后1、3个月组间差异均有统计学意义(P<0.05)。结论研究发现下肢肌肉局部注射A型肉毒毒素结合康复治疗可以更好减轻脑卒中患者的肌张力,改善患者的痉挛步态。     

A型肉毒毒素注射联合运动疗法治疗脑卒中后肘关节屈曲痉挛的疗效观察

目的观察A型肉毒毒素注射运动疗法治疗对于脑卒中后肘关节屈肌痉挛患者肌张力和运动功能的影响。方法对20例脑卒中后肘关节屈曲痉挛患者,随机分为治疗组和对照组各15例。治疗组患者采用对于肘关节屈曲痉挛肌肉进行A型肉毒毒素注射结合运动疗法治疗,对照组采用口服巴氯芬药物治疗结合运动疗法治疗。在治疗前、治疗后第1周、第6周和第12周应用改良Ashworth量表(MAS)和Fugl-Meyer量表(FMA)上肢评估量表进行比较。结果 2组治疗后MAS评分及FMA评分均较治疗前呈持续下降趋势(P0.05,0.01),且治疗组更低于对照组(P0.05,0.01)。结论 A型肉毒毒素注射结合运动疗法对降低脑卒中患者肘关节屈肌肌张力,提高运动功能及生活自理能力更加优于普通治疗。     

肌电引导下A型肉毒毒素治疗脑卒中后肢体肌痉挛临床观察

目的 探讨A型肉毒毒素治疗脑卒中后肢体肌痉挛的疗效.方法 选取70例脑卒中后肢体肌肉痉挛的病人,随机分为治疗组36例,在肌电引导下肌内注射A型肉毒毒素,同时辅以常规肢体功能训练.对照组34例,行常规肢体训练.结果 36例病人均在注射后1周内肌张力下降,2周～2个月内达到明显效果(P＜0.05),6个月后21例复发,痉挛程度较注射前轻.未发现明显全身并发症.结论 肌电引导下肌内注射A型肉毒毒素治疗脑卒中后肢体肌痉挛安全有效,操作简单,并发症少,值得在临床推广.     

重复经颅磁刺激联合重复注射A型肉毒毒素对脑卒中后下肢肌肉痉挛状态的临床疗效和安全性研究

目的观察脑卒中后下肢肌肉痉挛患者行重复经颅磁刺激(rTMS)联合A型肉毒毒素(BTX-A)重复注射的治疗效果及安全性。方法选择2013年7月至2016年7月于本院康复科治疗的伴有下肢肌肉痉挛的脑卒中患者共96例,按照随机数字表法分为4组:A组,康复治疗;B组,rTMS+康复治疗;C组,重复注射BTX-A+康复治疗;D组,rTMS+重复注射BTX-A+康复治疗。治疗前及治疗后1、6和12个月对4组患者采用改良Ashworth痉挛量表(MAS)评定肌张力,Fugl-Meyer下肢运动功能量表(FMA)评定下肢运动功能,采用改良Barthel指数量表(MBI)评定患者日常生活能力,Berg平衡量表(BBS)评定患者平衡能力。并观察患者在治疗的过程中的不良反应情况。结果与治疗前相比,治疗后1、6、12个月,B、C、D组的MAS评分呈下降趋势,D组最为明显(P<0.05);4组患者治疗1个月后FMA评分、MBI评分、BBS评分均升高,治疗后6、12个月,A、B、C组的FMA评分、MBI评分、BBS评分有下降或回升,D组的评分都呈上升趋势,均高于其他3组(P<0.05);治疗过程中,4组均无严重不良反应情况发生。结论 rTMS联合重复注射A型肉毒毒素能够有效降低脑卒中后下肢肌肉痉挛患者的肌肉张力,提高患者的生活质量,治疗效果较为持久,无不良反应,有临床应用价值。     

A型肉毒毒素治疗面肌痉挛60例的疗效观察

目的 评估A型肉毒毒素治疗面肌痉挛的疗效,并探讨减少基其并发症的方法。方法 将60例患者随机分为A、B两组,A组对上、下睑及面肌进行多点注射A型肉毒毒素;B组仅对下睑及面肌进行多点注射。对治疗前后的病情分级及两组间的疗效、睑下垂副作用发生情况进行对比,并观察A型肉毒毒素治疗后残留的和完全缓解后部分性复发的痉挛症状应用得理多治疗的疗效。随访副作用发生情况及疗效维持时分复发性痉挛症状有效。A型肉毒毒素副作用少。结论 A型肉毒毒素治疗面肌痉挛,安全有效,简单易行,为治疗面肌痉挛的首选方法。     

康复训练与A型肉毒毒素对痉挛性脑瘫患儿肌张力恢复及日常生活能力的影响

目的探讨康复训练联合A型肉毒毒素注射液治疗痉挛性脑瘫对患儿肌张力恢复及日常生活能力影响。方法选取驻马店市中心医院2014-08—2016-09痉挛性脑瘫患儿93例,采用随机数字表法分组,对照组46例予以A型肉毒毒素注射液治疗,研究组47例予以A型肉毒毒素注射液与康复训练联合治疗,2组均持续治疗20 d,分析2组治疗前后运动功能(Fugl-Meyer)、痉挛状态(CSS)、日常生活能力(Barthel)、肌张力(MAS)评分变化情况。结果 2组治疗前Fugl-Meyer、Barthel评分对比差异无统计学意义(P0.05),研究组治疗后Fugl-Meyer、Barthel评分与对照组比较明显提高,差异有统计学意义(P0.05);2组治疗前CSS、MAS评分对比差异无统计学意义(P0.05),研究组治疗后CSS、MAS评分与对照组比较明显降低,差异有统计学意义(P0.05)。结论 A型肉毒毒素注射液与康复训练联合治疗痉挛性脑瘫,可显著改善患儿肌张力及日常生活能力。     

A型肉毒毒素对脑出血轻度下肢痉挛患者康复效果的影响

目的探讨A型肉毒毒素对脑出血轻度下肢痉挛患者康复效果及生活质量的影响。方法选取本院2012-10—2014-10收治的84例脑出血轻度下肢痉挛患者为研究对象,根据随机数字表将患者分为观察组及对照组各42例,对照组给予常规康复训练,观察组在对照组基础上辅以电刺激引导A型肉毒毒素注射治疗,2组均治疗6个月。分别于治疗前、治疗1个月、3个月、6个月分别采用改良Ashworth(MAS)、临床痉挛指数(CSI)、Berg平衡量表(BBS)及Fugl-Meyer运动功能量表(FMA)、独立性评定量表(FIM)、Barthel指数评分及Gaitwatch量表对2组下肢运动功能及步态进行评定。采用卒中影响量表(SIS)对2组生存治疗进行评价。结果观察组治疗3个月、6个月后观察组MAS评、CSI评分低于对照组(P0.05),观察组3个月、6个月后BBS评分、FMA评分、FIM评分、Barthel指数高于对照组(P0.05)。观察组治疗1个月、3个月、6个月步频、步速、步长等指标均优于对照组(P0.05)。观察组治疗1个月、3个月、6个月SIS评分显著高于对照组(P0.05)。结论早期注射A型肉毒毒素能有效改善脑出血下肢痉挛患者肌张力,提高其平衡功能及运动功能,提高患者日常生活能力及生活质量,效果理想,值得推广应用。     

A型肉毒毒素治疗痉挛性斜颈及Meige''''s综合征的临床研究

目的　探讨A型肉毒毒素局部注射治疗痉挛性斜颈、Meige s综合征及职业性痉挛的疗效。方法　对 2 3例痉挛性斜颈、10例完全型Meige s综合征及 1例职业性痉挛患者进行A型肉毒毒素局部注射 ,观察其治疗效果以及副作用。结果　 2 3例痉挛性斜颈患者 ,治疗后Tsui量表评分明显下降 ;10例完全型Meige s综合征 ,8例明显好转 ,2例部分缓解 ;1例职业性痉挛患者完全缓解。所有患者均未见过敏反应和严重副反应。结论　A型肉毒毒素局部肌肉注射是治疗痉挛性斜颈等肌张力障碍的有效手段。     

不同定位方式下不同剂量肉毒毒素治疗痉挛性脑瘫的疗效观察

目的 观察不同定位方式下靶肌肉注射不同剂量A型肉毒毒素(BTX-A)治疗儿童痉挛性脑瘫的疗效.方法 选择厦门市妇幼保健院儿童神经康复科收治的痉挛性脑瘫患儿120例,分别应用肌电图定位及反向徒手牵拉定位(各60例),再分别按痉挛肌肉局部注射BTX-A剂量(3 U/kg、4 U/kg及5 U/kg)各分为3组(各20例),注射后配合康复训练.随访3个月时患儿疗效,采用粗大运动评价最表(GMFM)评定患儿功能区的运动功能,改良Ashworth痉挛量表评定肌痉挛程度.结果 肌电图定位组较反向徒手牵拉定位组治疗后GMFM评分增加和Ashworth分级减轻,差异有统计学意义(P<0.05),但此两种定位方式下各不同剂量BTX-A组间治疗后GMFM评分和Ashworth分级差异无统计学意义(P>0.05).结论 在相同有效剂量BTX-A注射情况下,肌电图定位较反向徒手牵拉定位疗效更好.

Abstract：

Objective To observe the clinical effects of different doses of botulinum toxin A (BTX-A) and different lacation ways on children with spastic cerebral palsy. Methods One hundred and twenty patients with BTX-A were employed in our study;these patients were performed locations of electromyography (n=60) and reverse stretching hand (n=60), and then, they were equally sub-divided into 6 groups, respectively: receiving injection of BTX-A at doses of 3, 4 and 5 U/kg, respectively (n=20).After injection, they were commenced functional training for 3 months. The gross motor assessment scale (GMFM) was used to assess the motor function of functional areas in these children 3 months after the training. The modified Ashworth scale was used to assess the degree of muscle spasticity. Results The scores of GMFM in patients received treatment with location of electromyography increased as compared with those with reverse stretching hand (P< 0.05), but the scores had no statistically significances among different doses of BTX-A treatment groups (P> 0.05). The Ashwort grade in patients received treatment with location of electromyography alleviated as compared with those with reverse stretching hand (P<0.05), but no statistically significance of grading was noted among different doses of BTX-A treatment groups (P>0.05). Conclusion All parameters in patients received treatment with location of electromyography improve better than those with reverse stretching hand after injection of same dose of BTX-A.     

Functional outcome of botulinum toxin A injections to the lower limbs in cerebral palsy

We evaluated gross motor function following botulinum toxin A (BTX-A) injections in the lower limbs of children with spastic cerebral palsy in a randomized clinical trial, using a cross-over design. Forty-nine children (24 males, 25 females, age range 22 to 80 months) were randomly allocated to two groups: group 1 received BTX-A and physiotherapy, and group 2 received physiotherapy alone for 6 months. At the end of this period, group 2 received BTX-A and physiotherapy and group 1 continued with physiotherapy alone. Assessment measures were the Gross Motor Function Measure (GMFM), the Vulpe Assessment Battery (VAB), joint range of movement, the Modified Ashworth Scale, and a parental questionnaire. Sustained gains in gross motor function were found in both groups of children but the only additional benefit found in group 1 was a significant increase in fine motor rating on the VAB. By contrast, parents rated the benefit of treatment highly. It is likely that assessment at 3 and 6 months post injection was too late to demonstrate peak gross motor function response and that changes in GMFM are not sustained over 6 months with a single dose. Further studies should investigate changes over shorter time periods and consider covariables such as BTX-A dosage, number of injection sites, and the role of repeated injections combined with other interventions such as casting.     

早期康复治疗对急性脑梗死患者运动、肌痉挛及生活活动能力的影响

目的：应用Fugl-Meyer量表、改良Ashworth量表和简化巴氏指数量表（BI）分别进行评定,探讨早期康复治疗对急性脑梗死偏瘫患者运动功能、肌痉挛及日常生活活动能力（ADL）的影响。方法：选择急性脑梗死偏瘫患者90例,随机分为康复治疗组和对照组。康复治疗组在临床药物治疗的同时进行规范的康复训练,对照组给予临床药物治疗及未经指导的自我锻炼,在患者入组时和30d后分别进行有关的功能评定,评价两组的疗效。结果：治疗前两组的一般资料、运动功能、肌痉挛与ADL的评定差异无统计学意义（P〉0．05）,经30d治疗后,运动能力和BI均有一定程度的改善,改善幅度康复治疗组明显优于对照组（P〈0．05）,肌痉挛评分康复治疗组也明显优于对照组（P〈0．05）。结论：早期康复治疗有助于改善急性脑梗死偏瘫患者的运动、肌痉挛及生活活动能力。     

Medium-term functional benefits in children with cerebral palsy treated with botulinum toxin type A: 1-year follow-up using gross motor function measure

One of the main goals when treating spasticity is to relieve pain and improve function. Intramuscular injection of botulinum toxin type A (BTX-A) has gained widespread acceptance in the treatment of spastic cerebral palsy. Several studies have clearly shown the short-term functional benefit of BTX-A treatment. Information is limited, however, on the efficacy of medium and long-term regimens, using repeated injection of BTX-A. The aim of the present open-label, prospective study was to evaluate functional outcome in children with spastic cerebral palsy after 1 year of treatment with BTX-A, using the Gross Motor Function Measure (GMFM) as a validated outcome measure. Patients ( n =25, age 1.5–15.5 years) were treated with BTX-A for adductor spasm ( n =12) or pes equinus ( n =13). The local effect was evaluated using passive range of motion and modified Ashworth Scale. Apart from a significant improvement in joint mobility and reduction of spasticity compared to pretreatment values ( P  < 0.01), we demonstrated a significant improvement of gross motor function after 12 months of treatment, with a median gain of 6% in total and goal scores ( P  < 0.001). An increase in GMFM scores was particularly evident in younger and moderately impaired children (Gross Motor Function Classification System level III). Whether the observed improvement in gross motor function in children with cerebral palsy is specifically related to therapy with BTX-A or represents at least in part the natural course of motor development still needs clarification.     

束带强化核心稳定性训练结合感觉统合训练 对痉挛型脑性瘫痪患儿体位控制的影响

目的 探讨束带强化核心稳定性训练结合感觉统合训练对痉挛型脑性瘫痪(SCP)患儿体位控制的影响。方法 选取2014年6月-2017年6月本院收治的SCP患儿100例,依据随机数字表法分为束感组和常规组,每组各50例,常规组给予常规康复及感觉统合训练,束感组在此基础上给予束带强化核心稳定性训练,比较2组痉挛状态、粗大运动功能、体位控制。结果 束感组痉挛改善有效率明显高于常规组(P<0.05); 束感组和常规组治疗3、6个月后粗大运动功能量表(GMFM)、Berg平衡量表(BBS)得分明显高于治疗前,束感组治疗3、6个月后GMFM、BBS得分明显高于常规组(P<0.05)。结论 束带强化核心稳定性训练结合感觉统合训练可有效缓解SCP患儿的痉挛症状,有利于改善患儿粗大运动功能、体位控制能力。     

Motor impairments in young children with cerebral palsy: relationship to gross motor function and everyday activities

In this study we assessed the distribution of spasticity, range of motion (ROM) deficits, and selective motor control problems in children with cerebral palsy (CP), and examined how these impairments relate to each other and to gross motor function and everyday activities. Ninety-five children (55 males, 40 females; mean age 58 months, SD 18 months, range 25 to 87 months) were evaluated with the modified Ashworth scale (MAS), passive ROM, the Selective Motor Control scale (SMC), the Gross Motor Function Measure (GMFM), and the Pediatric Evaluation of Disability Inventory (PEDI). Types of CP were hemiplegia (n=19), spastic diplegia (n=40), ataxic diplegia (n=4), spastic quadriplegia (n=16), dyskinetic (n=9), and mixed type (n=7). Severity spanned all five levels of the Gross Motor Function Classification System (GMFCS). The findings highlight the importance of measuring spasticity and ROM in several muscles and across joints. Wide variability of correlations of MAS, ROM, and SMC indicates a complex relationship between spasticity, ROM, and selective motor control. Loss of selective control seemed to interfere with gross motor function more than the other impairments. Further analyses showed that motor impairments were only one component among many factors that could predict gross motor function and everyday activities. Accomplishment of these activities was best predicted by the child's ability to perform gross motor tasks.     

镜像疗法对偏瘫患者上肢功能康复疗效的观察

目的 观察镜像疗法对卒中后偏瘫患者上肢功能康复的疗效。方法 选择30例入选卒中后8周内偏瘫患者随机分为两组：镜像疗法组和对照组,分别于治疗前及治疗后4周采用Fugl-Meyer运动评价（Fugl-Meyer motor assessment,FMA）（上肢部分）,上肢运动研究测试（the action research arm test,ARAT）、运动功能评估量表（motor assessment scale,MAS）对上肢运动功能进行评分,同时评定患者的视觉模拟评分（visual analogue scale/score,VAS）、痉挛程度以及改良Barthel指数,以观察镜像疗法对偏瘫患者上肢功能康复的疗效。结果 治疗4周后,两组上肢运动能力FMA评分、ARAT评分、MAS评分、改良Barthel指数均较治疗前提高（P＜0.01）;治疗组FMA评分、ARAT评分高于对照组（P＜0.05）,两组间MAS评分、改良Barthel指数提高,但差别无统计学意义（P＞0.05）。治疗组VAS评分较治疗前有下降（P＜0.05）,但对照组治疗前后,VAS评分差异无统计学意义（P＞0.05）,治疗后两组间的VAS差异有统计学意义（P＜0.05）。两组治疗前后及治疗后组间痉挛改善差异无统计学意义（P＞0.05）。结论 镜像疗法能提高偏瘫患者的上肢运动功能,且能减轻患者偏瘫上肢的疼痛,但对患者日常生活活动能力（activity of daily living scale,ADL）及患肢痉挛程度的改善无明显影响。     

Pedobarometric evaluation of equinus foot disorder after injection of botulinum toxin A in children with cerebral palsy: a pilot study

The purpose of this pilot study was to evaluate the effect of treatment with botulinum toxin A (BTX-A) injections on function in children with cerebral palsy (CP) using pedobarometric data collected in a standing position. Ten children with CP (seven males, three females) participated, five with diplegia and five with hemiplegia. All children exhibited signs of unilateral dynamic equinus foot disorder and were community ambulators. Age range at the time of treatment was 6 to 13 years (mean age 9 y, SD 2.5). A comprehensive clinical examination and a pedobarometric evaluation were performed before and after BTX-A injection. All children received at least one injection in each spastic muscle. BTX-A was given to eight children unilaterally and to two children bilaterally. A maximum dose of 4 to 8 units of BTX-A per kilogram body weight was administered. In comparison with pretreatment values, the pedobarometric evaluation revealed a significant increase in the whole plantar surface area on the affected side (p < 0.05), an increase in the peak pressure value at the hindfoot on the affected side (p < 0.05), and a significant shift in the body centre of mass to the affected limb (p < 0.05) 1 month after treatment with BTX-A. A significant decrease in the peak pressure value at the hindfoot on the unaffected side was also observed. Similarly, a decrease in the modified Ashworth scale and an increase in the range of motion were observed. Thus, BTX-A produces a significant plantar surface modification and a significant shift of the body centre of mass which represents an indirect measure of postural attitude. Pedobarometric evaluation can also be useful in quantifying clinical changes after treatment with BTX-A.     

氟西汀对急性前循环脑梗死运动恢复的临床研究

目的 观察氟西汀对急性前循环脑梗死3个月后运动功能的恢复作用.方法 选择入院的急性前循环缺血性脑梗死偏瘫患者60例,平均年龄46～70岁.采用单盲法随机分为治疗组和对照组各30例,治疗组在给予常规治疗的同时,在发病3～10 d内晨服氟西汀20 mg,1次/d,持续3个月.对照组给予常规治疗.3个月后使用FuglMeyer 量表（FMA）评价患者上肢运动功能,应用功能独立性评定量表（FIM）评价进食、梳洗、穿脱上衣等功能.结果 3个月后治疗组FuglMeyer motor scale （FMMS）及FIM评分明显高于对照组（P〈0.05）,差异有统计学意义.结论 及早的给予氟西汀,有助于运动功能的改善,氟西汀可能参与促进神经功能的修复.     

A randomized controlled trial comparing botulinum toxin A dosage in the upper extremity of children with spasticity

This study compared the effects of low and high doses of botulinum toxin A (BTX-A) to improve upper extremity function. Thirty-nine children (22 males, 17 females) with a mean age of 6 years 2 months (SD 2y 9mo) diagnosed with spastic hemiplegia or triplegia were enrolled into this double-blind, randomized controlled trial. The high-dose group received BTX-A in the following doses: biceps 2U/kg, brachioradialis 1.5U/kg, common flexor origin 3U/kg, pronator teres 1.5U/kg, and adductor/opponens pollicis 0.6U/kg to a maximum of 20U. The low-dose group received 50% of this dosage. Outcomes were measured at baseline and at 1 and 3 months after injection, and results were analyzed with a repeated-measures analysis of variance. There was no significant difference between the low-dose and high-dose groups in upper extremity function over the 3-month period as measured by the Quality of Upper Extremity Skills Test (F[1,37]=0.18, p=0.68). There was no difference between the groups in the Pediatric Evaluation of Disability Inventory Self Care Domain (F[1,37]=0.05, p=0.83). Although grip strength decreased over the 3-month period, there was no difference between groups (F[1,32]=0.45, p=0.51). These findings indicate that there is no difference in hand and arm function between a low dose and a high dose of BTX-A at 1 and 3 months after injection. This information can be used to guide dosage of BTX-A for the management of upper extremity spasticity in children.