A型肉毒毒素注射配合康复训练治疗痉挛型脑性瘫痪儿童下肢肌张力障碍

目的探讨A型肉毒毒素（BTX-A）在脑性瘫痪（脑瘫）治疗中的应用及疗效。方法将34例痉挛型双瘫患儿随机分为治疗组和对照组，治疗组采用BTX-A局部多点注射结合康复训练，对照组仅行康复训练，2组治疗前及治疗后3d、2周、1个月、2个月和3个月采用改良的Ashworth痉挛分级量表、粗大运动功能量表（GMFM）及印油毯足印分析进行疗效评估。结果治疗组治疗3d后，对照组治疗1个月后痉挛评分下降。与治疗前比较，差异有统计学意义（P〈0．05）；治疗2周至3个月，2组痉挛评分比较，差异有统计学意义（P〈0．05）。2组治疗1个月和3个月后GMFM评分均有提高，治疗3个月后治疗组与对照组相比，差异有统计学意义（P〈0．05）。印油毯足印分析显示，治疗组治疗3个月后步行足长、步速与治疗前及与对照组比较，差异有统计学意义（P〈0．05），步幅评分2组均有明显提高（P〈0．05），但组问差异无统计学意义（P〉0．05）。结论BTX-A注射配合康复训练可快速有效地缓解脑瘫患儿下肢痉挛及提高其步行功能，缩短住院疗程。

A clinical study of botulinum toxin injection in conjunction with rehabilitation training for juvenile cerebral palsy patients with spastic diplegia

Objective To study the clinical effects of botulinum toxin A ( BTA ) injection in conjunction with rehabilitation training (RT) in the treatment of juvenile cerebral palsy (CP) involving spastic diplegia (SD). Methods Thirty-four patients were randomly divided into a treatment group ( group 1 ) and a control group ( group 2). The sixteen patients in group 1 were treated with BTA and RT, while those in group 2 were treated with RT alone. The modified Ashworth scale ( MAS) , the gross motor function measure ( GMFM) and gait analysis were performed before treatment and at 3 days, 2 weeks, and 1 , 2 and 3 months after treatment. Results The spasticity scores in group 1 had decreased by day 3 of the treatment, and in group 2 after 1 month. The MAS and GMFM scores in group 1 were significantly better than those in group 2. Gait analysis showed a significant increase in the walking foot length and walking speed in group 1. Step length was improved in both groups, with no significant difference between them. Conclusion BTA injection in conjunction with RT was effective for reducing spasticity and improving functional performance in standing and walking in children with CP and SD.