摘要：
Objective: To compare the clinical outcome of two different location techniques: manual palpation guidance and ultrasound guidance, for botulinum toxin type A injection into calf muscles in the treatment of spastic equinovarus in stroke patients.Method: Forty stroke patients with equinovarus were randomly assigned into two groups. All patients of both groups received injection of 300U botulinum toxin A in gastrocnemius, soleus and tibialis posterior muscles. The group A(n=18) was applied manual palpation-guided technique for location of injection. The group B(n=20) was applied ultrasound-guided technique for location of injection. Modified Ashworth scale(MAS), physician rating scale (PRS), speed of gait, passive range of motion(PROM) of ankle dorsiflexion and eversion were measured at baseline, and the 2nd, 4th, 8th, 12th week after treatment.Result: In each group, after treatment, the measurement indexes of MAS, gait pattern scale, speed of gait, PROM of ankle dorsiflexion and eversion all improved significantly(P＜0.05). Group B improved significantly in MAS,PRS,speed of gait, PROM of ankle dorsiflexion and eversion at the 4th week(P＜0.05), in MAS and PROM of ankle dorsiflexion at the 8th week(P＜0.05), in MAS, speed of gait and PROM of ankle eversion at the 12th week comparing with group A(P＜0.05). Comparing the trend of variations of measurement indexes during follow-up periods in two groups there was no statistical difference.Conclusion: The correction of equinovarus in stroke patients could be obtained by injecting botulinum toxin type A. Ultrasound-guided technique was considered to be a valid alternative technique for location of injection, which got superior clinical results than manual palpation-guided technique in some respects.%目的:比较超声引导下注射和徒手肌肉定位法在肉毒毒素注射治疗脑卒中患者足下垂内翻的临床效果.方法:46例符合纳人标准的脑卒中后足下垂内翻患者,随机分为A组和B组,38例完成本研究.A组(n=18),接受徒手定位注射;B组(n=20),接受超声引导注射.两组均注射A型肉毒毒素300U到腓肠肌、比目鱼肌、胫骨后肌.在患者注射前,注射后第2、4、8、12周采用改良Ashworth量表(MAS)、医生评价量表(PRS)、步速、踝关节被动活动度(背屈、外翻)评价临床效果.结果:组内比较,注射后各评价指标比注射前进步,差异有显著性意义(P<0.05).比较两组间的进步值,B组在第4周时MAS、PRS、步速、踝关节被动活动度(背屈、外翻)比A组明显进步(P<0.05);第8周时,MAS、踝关节被动活动度(背屈)比A组明显进步(P<0.05);第12周时,MAS、步速、踝关节被动活动度(外翻)比A组明显进步,差异有显著性意义(P<0.05).比较两组间各测量指标随时间变化的趋势.差异无显著性意义.结论:A型肉毒毒素注射能改善脑卒中患者足下垂内翻症状,超声引导注射比徒手肌肉定位法在某些方面获得更好的临床效果.
