A型肉毒毒素注射联合功能训练对痉挛型脑瘫患儿尖足畸形、粗大运动功能及智力发育的影响研究

摘要

目的 探讨A型肉毒毒素(BTX-A)注射联合功能训练对痉挛型脑瘫(SCP)患儿尖足畸形、粗大运动功能及智力发育的影响.方法 选取2012年4月-2015年10月河南省中医院收治的SCP患儿66例.按照随机数字表法将患者分为对照组(n=33)和观察组(n =33).对照组予以功能训练,包括被动关节活动度训练、肌力训练、步行训练;观察组在对照组的基础上接受BTX-A注射治疗.于治疗前和治疗后3个月,观察和比较两组患儿的下肢痉挛程度、踝关节被动背屈角度、粗大运动功能发育情况、智力发育水平、日常生活活动能力(ADL),并观察治疗过程中的不良反应.结果 (1)下肢痉挛程度:两组治疗前后综合痉挛量表(CSS)评分差值比较,差异有统计学意义(t =4.388,P＜0.01).(2)踝关节被动背屈角度:两组治疗前后左足背屈角度、右足背屈角度差值比较,差异均有统计学意义(t值分别为3.937、3.060,P＜0.01).(3)粗大运动功能发育情况:两组治疗前后粗大运动功能量表(GMFM)的D、E区评分差值比较,差异均有统计学意义(t值分别为17.207、7.559,P＜0.01).(4)智力发育水平:两组治疗前后婴幼儿智力发育量表(CDCC)的智力发育指数(MDI)和心理运动发育指数(PDI)差值比较,差异均无统计学意义(t值分别为1.733、1.746,P＞0.05).(5) ADL评分:两组治疗前后ADL评分差值比较,差异有统计学意义(t=6.792,P＜0.01).(6)不良反应:两组患者均未发生明显的不良反应.结论 BTX-A注射联合功能训练能有效改善SCP患儿尖足畸形和粗大运动功能,不会对智力发育产生影响,并能提高患儿ADL.%Objective To evaluate the effect of botulinum toxin type A (BTX-A) injection combined with function training on pointed foot deformity,gross motor function and mental development in children with spastic cerebral palsy (SCP).Methods We enrolled 66 cases of SCP who admitted in Henan Province Hospital of TCM from April 2012 to October 2015 and equally divided them into the control group and observation group based on the random number table.Both groups received the function training (passive joint mobility training,muscle strength training and walking training),the observation group additionally received the treatment with injections of BTX-A.The degree of lower limb spa sm,passive ankle-dorsiflexion,range of motion (ROM),development of gross motor function,mental development and activities of daily living (ADL) of the groups were observed and compared before and three months after treatment.Adverse reactions occurred inboth groups during the treatment were observed and compared.Results (1) Degree of lower limb spasm:the D-value between the two measurement results of CSS was much greater in the observation group than in the control group (t =4.388,P ＜ 0.01);(2) passive ankle-dorsiflexion ROM:the D-value between the two measurement results of left or right ankle dorsiflexion angle was greater in the observation group than in the control group (t =3.937,P ＜ 0.01;t =3.060,P ＜ 0.01);(3) development of gross motor function:the D-values between the two measurement results of dimensions D and E of GMFM were greater in the observation group than in the control group (t=17.207,P＜0.01;t=7.559,P＜0.01);(4) mental development:the D-values between the two measurement results of MDI and PDI indexes of CDCC Infant Mental Development Scale were similar in both groups (t =1.733,P ＞ 0.05;t =1.746,P ＞ 0.05);(5) scores of ADL:the D-value between the two measurement results of ADL was significantly greater in the observation group than in the control group (t =6.792,P ＜ 0.01);(6) adverse reactions:no obvious adverse reactions occurred in both groups during the treatment.Conclusion Injection of BTX-A combined with function training can effectively improve pointed foot deformity and gross motor function as well as the ADL ability in children with SCP without affecting the mental development.