A型肉毒毒素联合自家康复训练治疗痉挛型脑瘫

目的探讨A型肉毒毒素(botulinum toxin,BTX-A)联合自家康复训练治疗痉挛型脑瘫的临床疗效和经济学价值;初步探索步态分析仪在小儿脑瘫治疗效果评价中的作用。方法选择148例痉挛型脑瘫患儿分治疗组(83例)和对照组(65例),另选30例运动正常非脑瘫患儿作为正常组。治疗组自家康复训练辅以痉挛肌肉注射BTX-A,对照组由康复医师进行康复,观察2组患儿运动评价量表(physician rating scale,PRS)得分和所需医疗费用的变化。采用步态分析试验平台,对从治疗组中随机选择的30例患儿进行治疗前和治疗后1个月的疗效评价并与正常组进行比较。结果两种方法所需费用,治疗组明显低于对照组(P<0.000);治疗3个月和6个月后,治疗组PRS评分改善情况明显优于对照组(P<0.000);步态分析仪统计结果显示,治疗1个月后治疗组患者的膝、踝关节运动角度和步速改善情况较治疗前明显改善(P<0.05)与正常组比较差异无统计学意义。结论康复治疗联合BTX-A局部注射,较单纯康复治疗疗效好;费用较专业康复明显降低,简单易行;采用步态分析仪评价疗效,客观性强,结果可靠、准确。

Botulinum Toxin A Combining Home Rehabilitation for the Treatment of Spastic Cerebral Palsy

Objective To observe the curative effects and economical values of botulinum toxic A(BTX-A) combining home rehabilitation for treatment of spastic cerebral palsy(CP). As well as the application of gait analysis apparatus for the effective treatment of CP. Methods One hundred and forty eight children with CP were randomly divided into treatment group (83 cases) and control group(65 cases), and choose another 30 children with normal exercise and non-cerebral palsy as normal group. The treatment group received intramuscular injection of BTX-A and home rehabilitation. The control group received rehabilitation by professional physicians. Physician rating scale(PRS) and medical cost of both groups were assessed. Using gait analysis test platform, 30 cases of the treatment group received effectiveness evaluation before and 1 month after therapy. Results The PRS of treatment group on 3, 6 months after therapy improved more significantly than the control group(P<0.000). The cost in the treatment group was less than that of the control group(P<0.000). The ankle, knee joint movements and gait speed in the treatment group improved more significantly(P<0.000). Conclusion Rehabilitation combining intramuscular injection of BTX-A was better than single rehabilitation and its cost is lower than professional rehabilitation. It is objective, reliable and accurate in evaluating the curative effect with gait analysis apparatus.