论文部分内容阅读
目的 探讨A型肉毒毒素 (botulinumtoxinA ,BTXa)能否有效、安全地治疗下肢肌痉挛 ,改善步行能力及步行速度。方法 2 7例中风、脑外伤患者 ,选择下肢肌肉局部注射国产BTXa。每个病人每次选择 3～ 5块肌肉 ,每块肌肉总的注射剂量介于 5 0～ 10 0U ,每次病人接受的注射总量小于或等于 40 0U。所有病人同时接受步态训练等康复治疗。注射前、注射后 2、4wk按改良式Ashworth量表 (ModifiedAsh worthScale ,MAS)评定肌张力 ,足印分析法 (footprintanaly sis)测量并记录步行时的时间距离参数的变化 ,研究各肌群肌张力变化与步态参数的关系。结果 整体比较 ,注射后 2wk(股直肌除外 )、4wk与注射前相比 ,各肌群肌张力降低 ,差异有显著性 (P <0 0 5 ) ,步态时间距离参数值 (T D值 )除步角外 ,各参数均有不同程度改善 (P <0 0 1或 <0 0 5 )。注射前与注射后 4wk比较 ,步长、步宽、步速差异均有显著性(P <0 0 5 )。注射后 2wk与 4wk比较 ,步长、步速有改善(P <0 0 5 )而步宽、步角变化不大。spearman相关分析表明各肌群肌张力降低与步长具有较好的相关性。结论 BTXa下肢肌肉局部注射结合步态训练 ,可以明显改善中风、脑外伤的痉挛步态 ,由此显示局部的化学去神经方法与康复训练相结合 ,可以使特定的功能改?
Objective To investigate whether botulinum toxin A (BTXa) can effectively and safely treat the lower extremity muscle spasm and improve walking ability and walking speed. Methods Twenty-seven patients with stroke and traumatic brain injury were selected to receive local BTXa injection. Each patient chooses 3 to 5 muscles at a time. The total injected dose of each muscle ranges from 50 to 100 U, and the total amount of injections received by each patient is less than or equal to 40 0 U. All patients also received rehabilitation training in gait training. Before injection and at 2,4wk after injection, muscle tone was assessed by Modified Ashworth Scale (MAS), and the time-distance parameters of walking were measured and recorded by footprintanaly sis. The muscle tone Relationship between changes and gait parameters. Results Compared with before injection, the muscle tone of each muscle group decreased significantly at 2 weeks (except for rectus femoris) and 4 weeks after injection, with significant difference (P <0 05), gait time distance parameter (TD) In addition to the step angle, the parameters were improved to varying degrees (P <0 0 1 or <0 0 5). Before injection and 4wk after injection, the differences in step length, step width and pace were significant (P <0 05). Compared with 4wk after 2wk injection, the step length and pace speed improved (P <0 05) and the step width and pace angle changed little. Spearman correlation analysis showed that muscle tone decreased muscle strength and step size has a good correlation. Conclusions Local injection of BTXa muscle in combination with gait training can significantly improve the spastic gait of stroke and traumatic brain injury. This shows that the combination of local chemical denervation and rehabilitation training can make certain functional changes occur.