《中国康复理论与实践》

《中国康复理论与实践》 ›› 2010, Vol. 16 ›› Issue (11): 1047-1050.

• 论文 • 上一篇    下一篇

A型肉毒毒素注射配合功能训练对痉挛型脑瘫尖足畸形及

颜华，张惠佳，郭春光，何金华，苏珍辉，胡继红，周平秋，王益梅   

  1. 湖南省儿童医院康复中心，湖南长沙市 410007
  • 收稿日期:2010-05-14 修回日期:2010-07-30 出版日期:2010-11-25 发布日期:2010-11-25

Effects of Botulinum Toxin Type A Injection Combined with Functional Training on Tiptoe Deformation and Gross Motor Function in Children with Spastic Cerebral Palsy

YAN Hua, ZHANG Hui-jia, GUO Chun-guang, et al   

  1. Rehabilitation Central of Hunan Children's Hospital, Changsha 410007, Hunan, China
  • Received:2010-05-14 Revised:2010-07-30 Published:2010-11-25 Online:2010-11-25

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摘要： 目的探讨A型肉毒毒素(BTX-A)注射配合功能训练对痉挛型脑瘫患儿尖足畸形及粗大运动功能发育的影响。方法对60例痉挛型脑瘫患儿进行BTX-A注射，再配合功能训练；对照组46例仅进行功能训练。两组分别于注射治疗前及注射后1周、3个月采用综合痉挛评分量表（CSS）、踝关节被动背屈角度（PROM）测量及粗大运动功能量表(GMFM-88)之D区（站立）、E区（走跑跳）进行评估。结果BTX-A起效时间为注射后24～72 h，到达高峰时间为1～2周，疗效维持>3个月，不良反应极少。治疗组1周后、3个月后下肢CSS评分及3个月后踝关节PROM、GMFM之D区和E区评分均比对照组明显改善(P<0.01)，尖足消失。结论BTX-A注射配合功能训练可快速缓解脑瘫患儿下肢肌肉痉挛，纠正尖足畸形，扩大踝关节活动范围，促进粗大运动功能发育，提高疗效。

关键词: 脑性瘫痪, 痉挛, A型肉毒毒素, 功能训练, 尖足, 粗大运动功能

Abstract: ObjectiveTo study the effects of botulinum toxin type A (BTX-A) injection combined with functional training on the tiptoe deformation and gross motor function in children with spastic cerebral palsy (SCP). Methods60 SCP children with tiptoe deformation whose family consented to inject BTX-A were as treatment group and treated with BTX-A combined with function training, while other 46 SCP children as control group were only treated with functional training. They were assessed with Composite Spasticity Scale (CSS), the angle of ankle passive dorsiflexion motion and D and E domains of Gross Motor Function Measure (GMFM) before and 1 week, and 3 months after treatment. ResultsThe effect of BTX-A began from 24 to 72 h after injection, reached the peak from 1 to 2 weeks, maintained beyond 3 months with few side effects. There were significant differences between 2 groups in the outcome of CSS,the angle and the standing and walking value (GMFM) 1 week and 3 months after treatment (P<0.01). ConclusionBTX-A combined with functional training is more effective on reducing spasticity of the lower extremity, correcting the tiptoe deformation, increasing the range of ankle motion, improving gross motor function.

Key words: cerebral palsy, spasticity, botulinum toxin A, functional training, tiptoe, gross motor function