| 张永祥，张文洁，王强，李江，韩超，董延广，杨传美.胫骨前肌注射A型肉毒毒素对脑卒中痉挛性足下垂和足内翻患者步行功能的影响[J].中华物理医学与康复杂志,2018,40(12):899-902 |
| 胫骨前肌注射A型肉毒毒素对脑卒中痉挛性足下垂和足内翻患者步行功能的影响 |
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| DOI： |
| 中文关键词: 脑卒中 痉挛 A型肉毒毒素 踝关节 步态 |
| 英文关键词: Stroke Spasticity Botulinum toxin type A Ankles Gait Club foot Foot drop |
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| 中文摘要: |
| 目的 观察胫骨前肌注射A型肉毒毒素对脑卒中痉挛性足下垂和足内翻患者痉挛程度以及步行功能的影响。 方法 选取脑卒中痉挛性足下垂和足内翻患者56例，按随机数字表法将其分为胫骨前肌注射组（TA组）和常规注射组（CG组），每组患者28例。CG组患侧腓肠肌内侧头、腓肠肌外侧头、比目鱼肌均分２个位点注射BTX-A，每个位点各注射50U，胫后肌也分２个位点注射BTX-A，每个位点35U。TA组患者注射位点和剂量均于CG组相同，但增加胫骨前肌单个位点的注射，剂量30U。于注射前、注射2周后、注射4周后和注射12周后，分别对2组患者进行足跖屈肌群和内翻肌群行改良的Ashworth痉挛评定量表（MAS）评分、10m步行测定(10m-WT)、简式Fugl-Meyer运动功能量表(FMA)下肢部分评分以及起立-行走计时测试(TUG)。 结果 注射2周、4周和12周后，2组患者足跖屈肌群和内翻肌群的MAS评分较组内注射前均显著降低，差异均有统计学意义(P<0.05)，且TA组注射2周、4周和12周后足内翻肌群的MAS评分分别为（2.43±0.34）分、（2.32±0.62）分和（2.15±0.56）分，与CG组同时间点比较，差异均有统计学意义（P<0.05）。注射2周、4周和12周后，2组患者的10m-ＷＴ、FMA评分和TUG与组内治疗前比较，均显著改善，差异均有统计学意义(P<0.05)，且TA组注射2周和4周后的10m-ＷＴ、FMA评分和TUG与CG组同时间点比较，差异均有统计学意义（P<0.05）。 结论 胫骨前肌小剂量A型肉毒毒素注射可进一步改善脑卒中痉挛性足下垂和足内翻患者足内翻肌群的痉挛程度，并对其步行功能的改善有促进作用。 |
| 英文摘要: |
| Objective To observe the effect of injecting botulinum toxin type A (BTX-A) into the tibialis anterior muscle on spasm and the walking function of stroke survivors with spastic foot drop and strephenopodia. Methods Fifty-six stroke survivors with spastic foot drop and strephenopodia were randomly divided into a tibialis anterior injection group (Group TA) and a conventional injection group (Group CG), each of 28. Both groups had 50 U of BTX-A injected into the medial-lateral heads of the affected gastrocnemius and soleus muscles, and 35 U injected into each of two sites in the tibialis posterior. Group TA was additionally injected with 30 U in the tibialis anterior. Before the injection, as well as 2, 4 and 12 weeks afterward, both groups were evaluated using the modified Ashworth scale (MAS) for the plantar flexors and varus muscle groups, a 10-minute walking test (10 m-WT), a simple Fugl-Meyer assessment (FMA) of the lower limb and a timed up and go test (TUG). Results Before the injection, there were no statistically significant differences in the average MAS, 10 m-WT, FMA or TUG results between the two groups. After 2 weeks, however, the average MAS score of both groups had decreased significantly, and that improvement was maintained at 4 and 12 weeks after the injection. Moreover, 2, 4 and 12 weeks after the injection, significant differences in the average MAS score were observed between the two groups. The average 10m-WT results, FMA scores and TUG times of both groups also improved significantly, but there were significant differences between the two groups′ 10m-WT times and FMA scores after 2 and 4 weeks. Conclusions Injecting a small dose of BTX-A into the tibialis anterior can further relieve spasm in the tibialis anterior muscle and improve the walking ability of stroke survivors with spastic foot drop and strephenopodia. |
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