A型肉毒毒素治疗对痉挛型脑瘫患儿足底压力改变的影响

目的:探讨A型肉毒毒素(BTX-A)对痉挛型脑瘫患儿足底压力改变的影响。方法:213例痉挛型脑瘫患儿随机分为BTX-A组108例(BTX-A注射结合物理治疗)和对照组105例(单纯物理治疗)。2组患儿在医院接受2周康复治疗,之后在家接受10周家庭康复治疗。在治疗前、治疗后2周和12周,对2组患儿进行以下评定:足底压力测试仪测试足底各区压力占全足的百分比,粗大运动功能测试量表中的站立与步行功能项评定粗大运动功能,改良Ashworth量表评定痉挛程度,医师等级评价量表评定步态。结果:BTX-A组的足底各区压力分布、站立和步行功能、痉挛程度和步态,在治疗后2周、12周与治疗前比较,均有明显改善(P<0.05);对照组各项评分在治疗12周后才有明显改善(P<0.05);治疗后12周,2组间的足底各区压力分布、站立和步行功能、痉挛程度和步态进行比较,BTX-A组均明显优于对照组(P<0.05)。结论:BTX-A注射结合物理治疗更利于改善痉挛型脑瘫患儿的足底压力分布、缓解其肌肉痉挛、提高其步行能力、改善其步态。

Effects of botulinum toxin injection on foot pressure in children with spastic cerebral palsy

Objective: To compare the effects of botulinum toxin A (BTX-A) injection plus physiotherapy, or physiotherapy alone on the food pressure in children with spastic cerebral palsy (SCP). Methods: 213 children with SCP were randomly divided into two groups: BTX-A group (BTX-A injections combined with physical therapy, 108 cases) and control group (physical therapy, 105 cases). Two groups received 2 weeks of hospital-based physiotherapy, and 10 weeks of home-based physiotherapy. Outcome assessments included foot pressure measured by GHW type plantar pressure tester, modified Ashworth scale (MAS), D and E dimensions of the Gross Motor Function Measure (GMFM), and physician rating scale was determined before and 2, 12 weeks after treatment. Results: Children in BTX-A group showed an improvement of foot pressure, spasticity, standing and walking, gait 2 and 12 weeks after treatment as compared with those before treatment (P<0.05). These scores in control group were improved at 12th week only. Furthermore, there was significant difference in foot pressure, spasticity, standing and walking, gait between two groups at 12th week (P<0.05). Conclusion: BTX-A injection combined with physical therapy was advantageous in improving foot pressure, spasticity, walking, and gait in children with SCP.