A型肉毒素局部注射结合强化运动治疗对脑卒中后下肢痉挛患者步行能力的影响

目的初步观察A型肉毒素局部注射结合强化运动治疗对脑卒中后下肢痉挛患者步行能力的影响。方法将40例脑卒中后下肢痉挛患者根据随机数字表法分为治疗组和对照组,每组20例,对照组给予下肢痉挛肌群A型肉毒素局部注射加常规康复治疗,治疗组在此基础上强化运动治疗。分别于治疗前、治疗后4周、治疗后8周对2组患者进行MAS(改良Ashworth量表)、IEMG(肌表面肌电积分值)、PROM(被动关节活动度)、10m MWS(10m最快步行速度)、FMA(Fugl-Meyer运动功能)、PCI(生理消耗指数)评分。结果治疗4周及8周后,2组MAS、IEMG、PROM、10m MWS、FMA、PCI评分较组内治疗前均显著改善,差异有统计学意义(P0.05);治疗4周后,治疗组PROM(4.39±1.25)°、10 m MWS(18.12±3.47)m/s、FMA(25.16±2.55)分、PCI(0.51±0.21)等指标显著优于对照组,差异有统计学意义(P0.05),而MAS(1.54±0.48)分、IEMG(37.95±4.48)分等指标差异无统计学意义(P0.05);治疗8周后,治疗组PROM(4.42±1.01)°、10m MWS(14.11±2.83)m/s等指标显著优于对照组,差异有统计学意义(P0.05),而MAS(1.63±0.57)分、IEMG(46.94±8.17)分、FMA(26.44±2.12)分、PCI(0.47±0.15)等指标差异无统计学意义(P0.05)。结论 A型肉毒素局部注射结合强化运动治疗可改善脑卒中后下肢痉挛患者的步行能力,可作为一种康复治疗手段应用于临床。

The effects of local injection with botulinum toxin type A uniting with intensive physical therapy on walking abil-ity in patients with post-stroke spasticity of lower limbs

Objective To preliminaprily observe the effects of local injection with botulinum toxin type A uniting with in-tensive physical therapy on walking ability in patients with post-stroke spasticity of lower limbs.Methods Forty patients with post-stroke spasticity of lower limbs were randomly divided into treatment group and control group,20 patients in each group.The control group received local injection with botulinum toxin type A in the spastic muscles of lower limbs and other conventional re-habilitation therapy.The treatment group received intensive physical therapy on the basis of control group.Before and four,eight weeks after treatment,the two groups were comparatively scored in MAS(Modified Ashworth Scale),IEMG(muscle surface elec-tromyography integral value),PROM(passive range of motion),10 m MWS(10m fastest walking speed),FMA(Fugl-Meyer motor function)and PCI(physiological consumption index).Results Four and eight weeks after treatment,MAS,IEMG,PROM,10 m MWS,FMA and PCI scores were significantly improved in the two groups(P<0.05).Four weeks after treatment,PROM(4.39± 1.25)°,10 m MWS(18.12±3.47)m/s,FMA(25.16±2.55),PCI(0.51±0.21)and other indicators in the treatment group were significantly better than those in the control group,and all the differences were statistically significant(P<0.05),while the MAS (1.54±0.48)and IEMG(37.95±4.48)showed no significant differences(P>0.05).After eight-week treatment,PROM(4.42± 1.01)°,10 m MWS(14.11±2.83)m/s and other indicators in the treatment group were significantly superior to those in the con-trol group(P<0.05),but MAS(1.63±0.57),IEMG(46.94±8.17),FMA(26.44±2.12),PCI(0.47±0.15)and other indicators showed no significant differences(P>0.05).Conclusion Local injection with botulinum toxin type A uniting with intensive physi-cal therapy which can effectively improve walking ability in patients with post-stroke spasticity of lower limbs,should be consid-ered as an available rehabilitation therapy.