肉毒毒素注射结合功能训练对痉挛型脑瘫患儿站立与步行功能的影响

目的：观察A型肉毒毒素（BTX-A）注射结合功能训练对痉挛型脑瘫患儿站立与步行功能的影响。方法：100例痉挛型脑瘫患儿随机分为BTX-A组50例和对照组50例。BTX-A组采用BTX-A注射下肢痉挛肌群结合功能训练,对照组仅采用单纯的功能训练。患儿在治疗前和治疗后2周、3个月、6个月进行综合痉挛量表（CSS）评分及粗大运动功能量表（GMFM）中的D和E两项评分。结果：治疗后2周、3及6个月时,2组患儿CSS评分均较治疗前呈逐渐下降趋势（P〈0.05）,且在治疗后3及6个月时BTX-A组CSS评分更低于对照组（P〈0.05）;2组患儿GMFM（DE区）评分均较治疗前呈逐渐上升趋势（P〈0.05）,且在治疗后3及6个月时BTX-A组GMFM（DE区）评分更高于对照组（P〈0.05）。结论：肉毒毒素注射和单纯的功能训练均能缓解脑瘫患儿肢体痉挛,改善运动功能,但BTX-A注射结合功能训练能更有效缓解脑瘫患儿的肢体痉挛,提高其运动能力,能明显缩短治疗时间,改善患儿的步态,提高其站立与步行功能。

Effects of botulinum toxin A injection in combination with functional training on standing and walking in children with spastic cerebral palsy

Objective：To study the effects of botulinum toxin A（BTX-A）injection in combination with functional training on standing and walking in children with spastic cerebral palsy（SCP）.Methods：One hundred children with SCP were randomly divided into a BTX-A group and a control group（n=50each）.The children in the BTX-A group were treated with BTX-A injected into spastic muscles in the lower extremity combined with functional training,and those in the control group with functional training alone.Composite to Spasticity Scale（CSS）scores and Gross Motor Function Measure（GMFM）DE scores were recorded before and at 2nd week,and 3rd month and 6th month after treatment.Results：After treatment for 2weeks,3months and 6months,CSS scores in the lower extremity were significantly reduced as compared with those before treatment,and those at 3rd and 6th month after treatment were significantly lower than in the control group（P〈0.05）.The GMFM（DE）scores after treatment were significantly increased in both two groups as compared with those before treatment,and those at 3rd and 6th month after treatment were significantly higher than in the control group（P〈0.05）.Conclusion：BTX-A injection or functional training can release spastic muscles in the lower extremity,and improve their activity ability.BTX-A injection in combination with functional training is more effective on reducing spasticity and improving functional standing and walking in children with SCP.