超声联合电刺激引导下A型肉毒毒素注射对卒中早期患者肌痉挛的临床研究
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摘要
目的观察超声联合电刺激引导下A型肉毒毒素(BTX-A)注射对早期脑血管意外患者肌痉挛的影响。方法选取早期脑血管意外后小腿肌痉挛患者46例,随机分为治疗组(23例)及对照组(23例)。对照组给予常规康复训练,治疗组在常规康复训练基础上辅以超声联合电刺激引导下BTX-A注射治疗。于治疗前和治疗6周后分别采用改良Ashworth量表(MAS)、简化Fugl-Meyer量表(FMA)、世界卫生组织生存质量量表简表(WHOQOL-BREF)、表面肌电积分值(iEMG)对2组功能进行评定。结果经6周治疗后,治疗组较对照组改善,治疗组MAS、FMA、WHOQOL-BREF、iEMG评分显著高于对照组(P<0.05)。结论超声联合电刺激引导下A型肉毒毒素注射对早期脑卒中患者肌痉挛定位准确、安全有效。
Objective To observe the effect of ultrasound combined with electrical stimulation guided injection of botulinum toxin type A(BTX-A)for the treatment of spasticity in early cerebral vascular accident patients.Methods Forty-six early cerebral vascular accident patients with lower limb spasticity were divided randomly into two groups:treatment group(23patients)and control group(23 patients).Patients in control group got routine rehabilitation training,and those in treatment group were given ultrasound combined with electrical stimulation guided injection of botulinum toxin type A additionally.The functions of two groups were evaluated by using the modified Ashworth scale(MAS),Fugl-Meyer assessment(FMA),intergrated electromyography(iEMG),WHO Quality of Life-BREF(WHOQOL-BREF)before and six weeks after treatment.Results After six weeks of treatment,the treatment group improved much better than the control group.The average MAS,FMA,WHOQOL-BREF,iEMG score in treatment group were significantly higher than those of control group(P <0.05).Conclusion Ultrasound combined with electrical stimulation guided injection of botulinum toxin type A for the treatment of spasticity in early cerebral vascular accident patients is effective,accurate and safe.
Objective To observe the effect of ultrasound combined with electrical stimulation guided injection of botulinum toxin type A(BTX-A)for the treatment of spasticity in early cerebral vascular accident patients.Methods Forty-six early cerebral vascular accident patients with lower limb spasticity were divided randomly into two groups:treatment group(23patients)and control group(23 patients).Patients in control group got routine rehabilitation training,and those in treatment group were given ultrasound combined with electrical stimulation guided injection of botulinum toxin type A additionally.The functions of two groups were evaluated by using the modified Ashworth scale(MAS),Fugl-Meyer assessment(FMA),intergrated electromyography(iEMG),WHO Quality of Life-BREF(WHOQOL-BREF)before and six weeks after treatment.Results After six weeks of treatment,the treatment group improved much better than the control group.The average MAS,FMA,WHOQOL-BREF,iEMG score in treatment group were significantly higher than those of control group(P <0.05).Conclusion Ultrasound combined with electrical stimulation guided injection of botulinum toxin type A for the treatment of spasticity in early cerebral vascular accident patients is effective,accurate and safe.
引文
[1]陈庆梅,孙海伟,李莉,等.电刺激定位肉毒素注射治疗肌痉挛的临床研究[J].中国康复,2014,29(6):442-446.
[2]Kaji R,Osako Y,Suyama K,et al.Botulinum toxin type A in post-stroke upper limb spasticity[J].Curr Med Res Opin,2010,26(8):1983-1992.
[3]Metaxiotis D,Siebel A,Doederlein L.Repeated Botulinum toxin A injections in the treatment of spastic equines foot[J].Clin Orhop Relat Res,2002,394:177-185.
[4]张林果,李放.肉毒毒素治疗肢体痉挛状态的研究进展[J].中华物理医学与康复杂志,2015,37(6):475-477.
[5]中华医学会神经病学分会帕金森病及运动学障碍学组.肌张力障碍诊断与治疗指南[J].中华神经科杂志,2008,41(8):570-573.
[6]李建华,王健,郭铁成,等.表面肌电图诊断技术临床应用[M].杭州:浙江大学出版社,2015:103-107.
[7]李芳,安丙辰,郑洁皎.表面肌电图在脑卒中患者手神经肌肉功能评定中的应用[J],中国康复理论与实践,2015,21(3):280-283.
[8]李青青,吴宗耀,罗利平.表面肌电图的信度研究[J].中国康复医学杂志,2006,21(3):2224-227.
[9]燕铁斌.踝背屈和跖屈的最大等长收缩:脑卒中急性期患者与同龄健康人表面肌电图的对照研究[J].中华物理医学与康复杂志,2003,25(4):212-215.
[10]姜丽,窦祖林,温红梅,等.恢复期脑卒中患者膝关节最大等长收缩时大腿肌群表面肌电信号特征研究[J].中国运动医学杂志,2010,4:421-424.
[11]Schnitzler A,Roche N,Denormandie P,et al.Manual needle placement:accuracy of botulinum toxin A injections[J].Muscle Nerve,2012,46(4):531-534.
[12]Childers MK.The importance of electromyographic guidance and electrical stimulation for injection of botulinum toxin[J].Phys Med Rehabil Clin N Am,2003,14(4):781-792.
[13]Brashear A,Gordon MF,Elovic E,et al.Intramuscular injection of Botulinum toxin for the treatment of wrist and finger spasticity after stroke[J].N Engl J Med,2002,347(6):395-400.
[14]Wan X,Li F,Li J,et al.Amulticenter,double-blind,randomized,placebo.controlled study to evaluate the efficacy and safety of BOTOX(botulinum toxin type A)in Chinese subjects with post-stroke upper limb spasticity[J].Eur J Phys Rehabil Med,2012,48(Suppl 1):24-24.
[15]Ozcakir S,Sivrioglu K.Botulinum toxin in poststroke spasticity[J].Clin Med Res,2007,5(2):132-138.
[16]Cousins E,Ward A,Roffe C,et al.Does low-dose botulinum toxin help the recovery of arm function when given early after stroke?A phase II randomized controlled pilot study to estimate effect size[J].Clin Rehabil,2010,24(6):501-513.
[17]Hesse S,Mach H,Frohlieh S,et al.An early botulinum toxin A treatment in subacute stroke patients may prevent a disabling finger flexor stifness six months later:a randomized controlled trial[J].Clin Rehabil,2011,26(3):237-245.
[18]吴涛,董燕,李建华,等.早期肉毒毒素干预对脑卒中患者步态及其生活质量的影响[J].中华物理医学与康复杂志,2014,36(4):280-282.
[19]Gao F,Grant TH,Roth EJ,et al.Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors[J].Arch Phys Med Rehabil,2009,90(5):819-826.
[20]Kong KH,Chua KS,Lee J.Symptomatic upper limb spasticity in patients with chronic stroke attending a rehabilitation clinic:frequency,clinical correlates and predictors[J].J Rehabil Med,2010,42(5):453-457.
[2]Kaji R,Osako Y,Suyama K,et al.Botulinum toxin type A in post-stroke upper limb spasticity[J].Curr Med Res Opin,2010,26(8):1983-1992.
[3]Metaxiotis D,Siebel A,Doederlein L.Repeated Botulinum toxin A injections in the treatment of spastic equines foot[J].Clin Orhop Relat Res,2002,394:177-185.
[4]张林果,李放.肉毒毒素治疗肢体痉挛状态的研究进展[J].中华物理医学与康复杂志,2015,37(6):475-477.
[5]中华医学会神经病学分会帕金森病及运动学障碍学组.肌张力障碍诊断与治疗指南[J].中华神经科杂志,2008,41(8):570-573.
[6]李建华,王健,郭铁成,等.表面肌电图诊断技术临床应用[M].杭州:浙江大学出版社,2015:103-107.
[7]李芳,安丙辰,郑洁皎.表面肌电图在脑卒中患者手神经肌肉功能评定中的应用[J],中国康复理论与实践,2015,21(3):280-283.
[8]李青青,吴宗耀,罗利平.表面肌电图的信度研究[J].中国康复医学杂志,2006,21(3):2224-227.
[9]燕铁斌.踝背屈和跖屈的最大等长收缩:脑卒中急性期患者与同龄健康人表面肌电图的对照研究[J].中华物理医学与康复杂志,2003,25(4):212-215.
[10]姜丽,窦祖林,温红梅,等.恢复期脑卒中患者膝关节最大等长收缩时大腿肌群表面肌电信号特征研究[J].中国运动医学杂志,2010,4:421-424.
[11]Schnitzler A,Roche N,Denormandie P,et al.Manual needle placement:accuracy of botulinum toxin A injections[J].Muscle Nerve,2012,46(4):531-534.
[12]Childers MK.The importance of electromyographic guidance and electrical stimulation for injection of botulinum toxin[J].Phys Med Rehabil Clin N Am,2003,14(4):781-792.
[13]Brashear A,Gordon MF,Elovic E,et al.Intramuscular injection of Botulinum toxin for the treatment of wrist and finger spasticity after stroke[J].N Engl J Med,2002,347(6):395-400.
[14]Wan X,Li F,Li J,et al.Amulticenter,double-blind,randomized,placebo.controlled study to evaluate the efficacy and safety of BOTOX(botulinum toxin type A)in Chinese subjects with post-stroke upper limb spasticity[J].Eur J Phys Rehabil Med,2012,48(Suppl 1):24-24.
[15]Ozcakir S,Sivrioglu K.Botulinum toxin in poststroke spasticity[J].Clin Med Res,2007,5(2):132-138.
[16]Cousins E,Ward A,Roffe C,et al.Does low-dose botulinum toxin help the recovery of arm function when given early after stroke?A phase II randomized controlled pilot study to estimate effect size[J].Clin Rehabil,2010,24(6):501-513.
[17]Hesse S,Mach H,Frohlieh S,et al.An early botulinum toxin A treatment in subacute stroke patients may prevent a disabling finger flexor stifness six months later:a randomized controlled trial[J].Clin Rehabil,2011,26(3):237-245.
[18]吴涛,董燕,李建华,等.早期肉毒毒素干预对脑卒中患者步态及其生活质量的影响[J].中华物理医学与康复杂志,2014,36(4):280-282.
[19]Gao F,Grant TH,Roth EJ,et al.Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors[J].Arch Phys Med Rehabil,2009,90(5):819-826.
[20]Kong KH,Chua KS,Lee J.Symptomatic upper limb spasticity in patients with chronic stroke attending a rehabilitation clinic:frequency,clinical correlates and predictors[J].J Rehabil Med,2010,42(5):453-457.