管型石膏结合BTX-A治疗痉挛型脑性瘫痪的临床研究

目的:观察A型肉毒毒素(BTX-A)结合管型石膏固定对痉挛型脑瘫(CP)患儿坐、站、走功能及肌肉痉挛程度的影响,为痉挛型CP的治疗提供更多依据。方法:120例痉挛型CP患儿为研究对象,将其随机分为观察组和对照组各60例,对照组采用BTX-A注射治疗后行物理治疗及家庭康复指导,观察组在对照组治疗基础上予以管型石膏固定,在治疗前、治疗后1、3及6个月时分别用粗大运动功能测试量表88项(GMFM-88)和改良Tardieu量表(MTS)参数(X)对患儿进行评定。结果:除对照组在治疗6个月后GMFM-88的D区评分较治疗前差异无统计学意义外,2组在治疗1、3及6个月后,GMFM-88各区评分均较治疗前明显提高(均P<0.05),且观察组治疗6个月后GMFM-88各区评分较对照组均明显提高(均P<0.05);治疗1、3及6个月后,2组小腿三头肌和腘绳肌的MTS参数(X)评分均较治疗前明显降低(均P<0.05),且观察组在治疗6个月后较对照组同时间点比较均更低(均P<0.05)。结论:BTX-A结合物理治疗可明显改善CP患儿的肌肉痉挛程度及提高粗大运动功能,在此基础上结合管型石膏固定可延长远期疗效。

Clinical study of botulinum toxin-A injection combined with plaster tube fixation in the treatment of spastic cerebral palsy

Objective: To observe the clinical effect of plaster tube fixation combined with botulinum toxin-A (BTX-A) injection on the functions of sitting, standing and walking, as well as the degree of muscle spasm in children with spastic cerebral palsy (CP), in order to provide theoretical basis for treatment of CP. Methods: A total of 120 children with spastic CP were randomly and equally divided into treatment group and control group. Children in control group were treated with BTX-A injection on the basis of comprehensive rehabilitation and home rehabilitation guidance, and those in treatment group were given the plaster tube fixation additionally on the basis of the control group. A total of 88 items version of gross motor function measure (GMFM-88) and parameter X of Modified Tardieu Scale (MTS) were assessed before treatment, 1 month, 3 months, and 6 months after treatment. Results: Except for the control group after 6 months of treatment, the scores of GMFM-88 in zone D were not statistically different from those before treatment. The scores of each zone of GMFM-88 in the two groups after treatment for 1 month, 3 months and 6 months were significantly higher than those before treatment (all P<0.05), and the scores of each area of GMFM-88 in the treatment group were significantly higher than those in the control group after 6 months of treatment (all P<0.05). After 1 month, 3 months and 6 months of treatment, the MTS parameter (X) scores of the triceps and hamstrings in the two groups were significantly lower than those before treatment (all P<0.05), and those in the treatment group were significantly lower than those in the control group at the same time points after 6 months of treatment (all P<0.05). Conclusion: On the basis of comprehensive rehabilitation, BTX-A injection can significantly reduce muscle tension and improve gross motor function in children with CP. Meanwhile, their combination with plaster tube fixation could prolong the long-term effect of BTX-A injection.