A型肉毒毒素联合体外冲击波治疗脑卒中后上肢痉挛的临床研究

目的探讨A型肉毒毒素(BTX-A)联合体外冲击波(ESW)治疗脑卒中后上肢痉挛的疗效、安全性及有效性。方法选取60例脑卒中后上肢痉挛患者,随机分为对照组和观察组,各30例。对照组接受传统的常规康复治疗,包括物理因子治疗(神经肌肉电刺激、电子生物反馈治疗),运动疗法(Bobath技术、Brunnstrom技术、PNF技术、Rood技术),以及针灸、推拿等,观察组在上述基础上运用BTX-A注射联合ESW治疗。分别在治疗前和治疗2周、4周、6周后对两组患者的上肢肌张力、上肢运动功能及日常生活能力进行评估。结果治疗2周、4周、6周后,两组患者上肢改良Ashworth量表(MAS)评分均明显下降,且观察组在治疗后各时点的上肢MAS评分均低于对照组(均P<0.05)。治疗2周、4周、6周后,两组上肢Fugl-Meyer评定(FMA)量表评分、改良Barthel指数(MBI)评分均明显提高,且观察组在治疗后各时点的上肢FMA评分、MBI评分均高于对照组(均P<0.05)。结论与传统康复治疗相比,BTX-A联合ESW能更迅速且持久地缓解脑卒中患者上肢痉挛,提高患者的运动功能及日常生活能力,改善上肢屈曲关节的活动度,减轻患者肢体疼痛,安全可靠,值得推广应用。

Clinical research on type A botulinum toxin combined with extracorporeal shock wave in the treatment of upper limb spasticity after cerebral stroke

Objective To explore the efficacy,safety and feasibility of type A botulinum toxin(BTX-A)combined with extracorporeal shock wave(ESW)in treating upper limb spasticity after cerebral stroke.Methods A total of 60 patients with upper limb spasticity after cerebral stroke were enrolled,and they were randomly assigned to control group and observation group,with 30 cases in each group.The control group received traditional routine rehabilitation treatment,including physical therapy(neuromuscular electrical stimulation and electronic biofeedback),motor therapy(technology of Bobath,Brunnstrom,PNF and Rood),and acupuncture and massage,etc.,based on which the observation group employed BTX-A injection combined with ESW for treatment.The upper limb muscle tone,upper limb motor function,and activities of daily living before treatment,and 2,4,6 weeks after treatment were evaluated in the two groups.Results After 2,4,6 weeks of treatment,the scores of upper limb modified Ashworth scale(MAS)all decreased significantly,and the observation group yielded lower MAS scores after various time points of treatment as compared with the control group(all P<0.05).After 2,4,6 weeks of treatment,the Fugl-Meyer Assessment(FMA)scale scores of upper limb,modified Barthel index(MBI)scores all increased significantly,and the observation group yielded higher scores mentioned above after various time points of treatment as compared with the control group(all P<0.05).Conclusion Compared to the traditional rehabilitation treatment,BTX-A combined with ESW can relieve upper limb spasticity in patients with cerebral stroke more quickly and enduringly,improve the motor function and activities of daily living in patients,improve motor range of upper limb flexion joint,and alleviate limb pain of patients,which is safe and reliable,and thus it is worthy of promotion and application.