体外冲击波联合肉毒毒素治疗对痉挛型脑瘫运动功能和身体活动的影响

目的:探讨体外冲击波(ESW)联合肉毒毒素(BoNT-A)治疗对痉挛型脑瘫下肢运动功能和身体活动的影响。方法:将60例2~10岁痉挛型脑瘫儿童随机分为对照组和治疗组各30例,2组均接受患侧小腿三头肌BoNTA注射及常规康复治疗,治疗组在BoNT-A注射24h后给予低能量ESW治疗。治疗前后对2组患儿的改良Asworth分级(MAS)、粗大运动功能评分(GMFM)D区和E区、身体活动水平进行评估。结果:治疗后,2组患儿MAS评分降低、GMFM D区和E区评分均较治疗前明显增加(P<0.05),治疗组MAS降低和D区评分增加较对照组显著(P<0.05)。治疗后,2组患儿的静坐时间百分比减少、轻强度身体活动时间百分比增加(P<0.05),且治疗组改善幅度较对照组显著(P<0.05)。结论:ESW联合BoNT-A治疗是改善痉挛型脑瘫肌痉挛、站立功能及身体活动的有效方法,比单独BoNT-A治疗效果更佳。

Effects of extracorporeal shock wave therapy combined with botulinum toxin type A on motor function and physical activity in children with spastic cerebral palsy

Objective: To investigate the effect of extracorporeal shock wave (ESW) therapy combined with botulinum neurotoxin A (BoNT A ) on motor function and physical activity in children with spastic cerebral palsy. Methods: Sixty children with spastic cerebral palsy (2 10 years old) were randomized into control group and treatment group. Participants in both groups received BoNT A injection into triceps surae muscle of the affected limbs and regular rehabilitation therapy simultaneously. Additionally, the treatment group received ESW therapy 24 h after BoNT A injection. Modified Ashworth Scale (MAS), Gross Motor Function Measure (GMFM) and physical activity were assessed before and 3 months after treatment. Results: The scores of MAS decreased, and scores of GMFM at D and E regions increased in both groups after treatment (all P<0.05). These changes of MAS and GMFM D scores were more significant in treatment group than in control group (P<0.05). Both groups spent less percentage of time in sedentary behavior and more percentage of time in light activity after treatment (all P<0.05), and these changes were more significant in the treatment group than in the control group (P<0.05). Conclusion: Compared to BoNT A injection alone, its combination with ESW therapy can release muscle spasm, improve gross motor function and physical activity level more effectively in children with spastic cerebral palsy.