A型肉毒毒素联合目标性训练对脑卒中伴痉挛患者手腕功能与疼痛指数的影响

目的 探讨A型肉毒毒素联合目标性训练对脑卒中伴痉挛患者手腕功能与疼痛指数的影响.方法 选取2012年10月至2014年10月我院内科康复科收治的脑卒中伴上肢痉挛患者70例,采用随机数字表法分为观察组和对照组各35例.观察组在彩超引导下行A型肉毒素注射治疗再行目标性训练,对照组仅给予目标性训练,均以12周为一个疗程.治疗前后发放Fugl-Meyer量表(FMA)中上肢相关评分评估上肢运动功能,发放改良Ashworth量表(MAS)评分评估肌张力,日常生活能力(ADL)量表(Barthel指数)评估独立生活能力,视觉模拟评分(VAS)评估疼痛程度.结果 观察组治疗12周后的Fugl-Meyer量表中后肩部及前臂、肘部、腕部、手、协调性与速度、总分均明显高于对照组(14.59±3.24)分vs(11.26±1.85)分、(4.16±1.53)分vs(3.12±1.15)分、(6.58±1.36)分vs(3.35±1.67)分、(5.58±1.12)分vs(3.39±1.27)分、(2.56±0.74)分vs(1.31±0.15)分、(29.97±4.21)分vs(21.94±4.28)分],差异均有统计学意义(P<0.01);观察组治疗12周后的MAS评分、VAS评分均明显低于对照组(1.35±0.27)分vs(2.32±0.19)分、(1.02±0.97)分vs(3.21±1.63)分],ADL评分明显高于对照组(71.26±13.35)分vs(53.34±12.77)分],差异均有统计学意义(P<0.01).结论 彩超引导下行A型肉毒素注射联合目标性训练能够降低肌张力,缓解疼痛症状,提高上肢活动功能.

Effect of type A botulinus toxin combined with targeted training on the wrist function and pain indexes in patients with stroke complicated by spasm

Objective To investigate the effect of type A botulinus toxin combined with targeted training on the wrist function and pain indexes in patients with stroke complicated by spasm. Methods Seventy patients with stroke complicated by spasm who were treated in Department of Internal Medicine- Rehabilitation in our hospital be-tween October 2012 and October 2014 were selected and randomly divided into the observation group and the control group, with 35 patients in each group. The observation group was treated by ultrasound guided injection of type A botuli-num toxin, followed by targeted training. The control group was only given targeted training. 12 weeks was taken as a course of treatment and both of the two groups were treated for 1 course. Before and after treatment, the Fugl-Meyer scale (FMA) was issued to evaluate the motor function of upper limbs. Modified Ashworth scale (MAS) was used to eval-uate muscular tension. Activities of daily living (ADL) scale (Barthel index) was used to evaluate independent living abili-ty, and visual analog scale (VAS) was used to evaluate the pain degree. Results After 12 weeks of treatment, Fugl-Meyer scores of shoulder and forearm, elbow, wrist, hand, coordination and velocity and the total scores of the observation group were significantly higher than those of the control group (14.59±3.24) vs (11.26±1.85), (4.16±1.53) vs (3.12±1.15), (6.58± 1.36) vs (3.35±1.67), (5.58±1.12) vs (3.39±1.27), (2.56±0.74) vs (1.31±0.15), (29.97±4.21) vs (21.94±4.28), P<0.01]. After 12 weeks of treatment, MAS and VAS scores of the observation group were significantly lower than those of the control group (1.35 ± 0.27) vs (2.32 ± 0.19), (1.02 ± 0.97) vs (3.21 ± 1.63), P<0.05], while ADL score was significantly higher than that of the control group (71.26 ± 13.35) vs (53.34 ± 12.77), P<0.05]. Conclusion Ultrasound guided injection of type A botulinum toxin combined with targeted training can reduce muscle tension, relieve pain symptoms and improve the mo-tor function of upper limbs.