《中国康复理论与实践》

《中国康复理论与实践》 ›› 2015, Vol. 21 ›› Issue (06): 706-712.

• 特稿 • 上一篇    下一篇

不同定位技术引导A型肉毒毒素注射治疗脑卒中后足下垂内翻的效果

欧海宁，黄彬，周凯欣，黄卓群，邓万溪，卢伟焰   

  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2015-06-25 发布日期:2015-06-25

Comparison of Location Guided by Palpation, Ultrasound and Electromyography in Botulinum Toxin Type A Injection for Equinovarus in Stroke

OU Hai-ning, HUANG Bin, ZHOU Kai-xin, HUANG Zhuo-qun, DENG Wan-xi, LU Wei-yan   

  1. Department of Rehabilitation Medicine, Guangdong Provincial Hospital of TCM, Guangzhou, Guangdong 510120, China
  • Received:1900-01-01 Revised:1900-01-01 Published:2015-06-25 Online:2015-06-25

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被引次数

15

摘要： 目的 比较徒手定位、超声定位和肌电图定位下进行A型肉毒毒素(BTX-A)注射治疗脑卒中后足下垂内翻患者的临床疗效。方法 脑卒中后足下垂内翻患者被随机分成3组。徒手定位组(n=19)采用徒手触诊引导技术，超声定位组(n=21)采用彩色超声引导技术，肌电图定位组(n=19)采用肌电引导技术，三组患者均接受 BTX-A 300 U腓肠肌、比目鱼肌和胫骨后肌注射。在治疗前和治疗后2周、4周、8周、12周进行以下评定：改良Ashworth量表(MAS)、医生评价量表(PRS)、步行速度、踝关节背屈和外翻的被动活动范围(PROM)。结果 组内比较：三组患者的 MAS评分、PRS评分、步行速度、踝关节背屈和外翻的 PROM，在治疗后 2周、4周、8周、12周与治疗前相比均有显著性差异(P<0.05)。组间比较：超声定位组在 4周的 MAS评分，4周和 12周时的踝外翻 PROM改善优于肌电图定位组(P=0.046, P=0.008, P=0.038)；超声定位组在 4周时 MAS评分(P=0.015)、PRS评分(P=0.01)、踝背屈和外翻 PROM(P=0.003, P=0.011)，8周时的 MAS评分(P=0.002)、踝背屈 PROM(P=0.022)，12周时的 MAS评分(P=0.011)以及踝外翻PROM(P=0.018)改善优于徒手定位组；肌电图定位组在4周时的PRS评分、4周和8周时的踝背屈PROM改善优于徒手定位组(P=0.048, P=0.08, P=0.026)。但三组间各评价指标随时间改变的趋势无显著性差异(P>0.05)。结论 三种定位技术引导下注射BTX-A均能改善患者痉挛和步行能力，超声引导比肌电图引导在改善足内翻方面稍有优势，均优于徒手定位。

关键词: 脑卒中, 痉挛, A型肉毒毒素, 注射, 徒手定位, 肌电图定位, 超声定位

Abstract: Objective To compare the clinical effects of palpation, ultrasound and electromyography (EMG) guided injection of botulinum toxin type A (BTX-A) on spastic equinovarus in stroke patients. Methods Stroke patients with equinovarus were randomly assigned to palpation-guided group (n=19), ultrasound-guided group (n=21) and EMG-guided group (n=19). All of the patients received injection of BTX-A 300 U in gastrocnemius, soleus and tibialis posterior, guided in their own ways. They were measured with modified Ashworth Scale (MAS), Physician Rating Scale (PRS), speed of gait, passive range of motion (PROM) of ankle dorsiflexion and eversion before and 2 weeks, 4 weeks, 8 weeks, and 12 weeks after injection. Results Compared with the baseline, all the indexes significantly improved after injection in all the groups (P<0.05). Compared with the EMG-guided group, the ultrasound-guided group improved significantly MAS at 4 weeks, PROM of ankle eversion at 4 and 12 weeks (P=0.046, P=0.008, P=0.038). Compared with the palpation-guided group, the ultrasound- guided group improved significantly in MAS (P=0.015), PRS (P=0.01), PROM of ankle dorsiflexion and eversion (P=0.003, P= 0.011) at 4 weeks, in MAS (P=0.002) and PROM of ankle dorsiflexion (P=0.022) at 8 weeks, in MAS (P=0.011) and PROM of ankle eversion (P=0.018) at 12 weeks. Compared with the palpation-guided group, the EMG-guided group improved significantly in PRS at 4weeks, PROM of ankle dorsiflexion at 4 and 8 weeks (P=0.048, P=0.08, P=0.026). There was no significantly difference in the variations with the time among 3 groups. Conclusion The correction of equinovarus in stroke patients can be obtained by BTX-A injection with any type of guidance technique. Ultrasound-guided technique is considered a valid alternative, which has a slight advantage over EMG-guided technique. Both the EMG- and ultrasound-guided techniques obtained superior results to palpation-guided technique.

Key words: stroke, spasticity, Botulinum toxin type A, injection, palpation, electromyography guidance, ultrasound guidance