目的 研究不同剂量A 型肉毒毒素（BTX-A）腓肠肌注射对脑性瘫痪尖足的疗效。方法 痉挛型脑性瘫痪所致尖足患儿256 例按肌张力不同分为A、B 两组：A 组（肌张力1~2 级）147 例，随机分为BTX-A大剂量注射（A1 组，73 例） 和小剂量注射亚组（A2 组，74 例）；B 组（肌张力3~4 级）109 例，随机分为BTX-A 大剂量注射（B1 组，55 例）和小剂量注射亚组（B2 组，54 例）。A1、B1 组给予BTX-A 6 U/kg，A2、B2 组给予BTX-A 3 U/kg。注射前及注射后1、3、6、12 个月进行改良的 Ashworth 痉挛评定量表评定腓肠肌的肌张力及粗大运动评定量表（GMFM）评定下肢运动功能。结果 A1 和A2 组治疗前和治疗后Ashworth 分级和GMFM 评分的差异均无统计学意义。B 组大剂量注射BTX-A 可有效降低肌张力，改善下肢运功功能，与小剂量比较，差异有统计学意义（P<0.05）。A、B 两组患儿治疗后Ashworth 分级逐渐下降，治疗后3 个月时最低，之后逐渐恢复，治疗后12 个月分级恢复至治疗前水平；而两组治疗后GMFM 评分逐渐提高，治疗后12 个月评分最高，差异有统计学意义（P<0.05）。结论 脑性瘫痪尖足的患儿在进行BTX-A 注射时应根据肌张力的严重程度选择不同剂量。对于病情相对较重的患儿，采用大剂量注射则可更大程度地降低肌张力，改善运动功能。
Abstract
Objective To study the therapeutic effects of different doses of botulinum toxin A (BTX-A) injection on tiptoe deformation in children with cerebral palsy. Methods A total of 256 children with tiptoe deformation due to spastic cerebral palsy were classified into group A (muscle tension levels I-II, n=147) and group B (muscle tension levels III-IV, n=109). Group A was randomly divided into group A1 (injected with high-dose BTX-A, n=73) and group A2 (injected with low-dose BTX-A, n=74). Group B was randomly divided into group B1 (injected with high-dose BTX-A, n=55) and group B2 (injected with low-dose BTX-A, n=54). The dose of BTX-A was 6 U/kg for groups A1 and B1 and was 3 U/kg for groups A2 and B2. Before the injection and at 1,2,6, and 12 months after injection, the muscle tension of limbs was evaluated with the modified Ashworth Scale, and the recovery of motor function of lower limbs was assessed with the Gross Motor Function Measure (GMFM). Results Before and after treatment, there were no significant differences in Ashworth and GMFM scores between groups A1 and A2 (P>0.05). After treatment, group B1 had a significantly reduced Ashworth score and a significantly increased GMFM score, and group B1 had a significantly lower Ashworth score and a significantly higher GMFM score compared with group B2 (P<0.05). For groups A and B, Ashworth score gradually declined post-treatment, reached the lowest point at 3 months after treatment, and returned to the level before treatment at 12 months after treatment; GMFM score gradually increased post-treatment and reached the peak level at 12 months after treatment (P<0.05). Conclusions The level of muscle tension should be considered when BTX-A injection is used for treating tiptoe deformation in children with cerebral palsy. It makes no difference to use high-or low-dose BTX-A when the muscle tension level is within I-II, but high-dose BTX-A has a better performance in reducing muscle tension and improving motor function when the muscle tension level is within III-IV.
关键词
A型肉毒毒素 /
脑性瘫痪 /
尖足 /
儿童
Key words
Botulinum toxin A /
Cerebral palsy /
Tiptoe deformation /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 王雅洁, 闫桂英, 高宝勤, 等. A 型肉毒毒素治疗痉挛型脑性 瘫痪下肢肌群的剂量-反应关系研究[J]. 中国当代儿科杂志, 2007, 9(3): 247-248.
[2] Heinen F, Desloovere K, Schroeder AS, et al. The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy[J]. Eur J Paediatr Neurol, 2010, 14(1): 45-66.
[3] Edgar TS. Clinical utility of botulinum toxin in the treatment of cerebral palsy: comprehensive review[J]. J Child Neurol, 2001, 16(1): 37-46.
[4] Camargo CH, Teive HA, Zonta M, et al. Botulinum toxin type A in the treatment of lower-limb spasticity in children with cerebral palsy[J]. Arq Neuropsiquiatr, 2009, 67(1): 62-68.
[5] Py AG, Zein Addeen G, Perrier Y, et al. Evaluation of the effectiveness of botulinum toxin injections in the lower limb muscles of children with cerebral palsy. Preliminary prospective study of the advantages of ultrasound guidance[J]. Ann Phys Rehabil Med, 2009, 52(3): 215-223.
[6] Kinnett D. Botulinum toxin A injections in children: technique and dosing issues[J]. Am J Phys Med Rehabil, 2004, 83(10): S59-S64.
[7] 中华儿科杂志编辑委员会、中华医学会儿科学分会神经学组. 小儿脑性瘫痪的定义、诊断条件及分型[J]. 中华儿科杂志, 2005, 43(4): 262.
[8] Bohannon RW, Smith MB, Interrater reliability of a modified Ashworth scale of muscle spasticity[J]. Phys Ther, 1987, 67(2): 206-207.
[9] 史惟, 王素娟, 杨红, 等. 中文版脑瘫儿童粗大运动功能分 级系统的信度和效度研究[J]. 中国循证儿科杂志, 2006, 1(2): 122-129.
[10] 刘青, 曹建国, 贠国俊. 体外冲击波疗法在肌肉痉挛治疗中 的应用[J]. 中国康复, 2014, 29(1): 65-67.
[11] Aoki KR. Harmacology and immunology of botulinumtoxin type A[J]. Clin Dermatol, 2003, 21(6): 476-480.
[12] Polak F, Morton R, Ward C, et al. Double-blind comparison study of two doses of botulinum toxin A injected into calf muscles in children with hemiplegic cerebral palsy[J]. Dev Med Child Neurol, 2002, 44(8): 551-555.
[13] Baker R, Jasinski M, Maciag-Tymecka I, et al. Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, double-blind, placebo-controlled, dose-ranging study[J]. Dev Med Child Neurol, 2002, 44(10): 666-675.
[14] 蔡淑英, 彭桂兰. 不同定位方式下肉毒素治疗儿童痉挛型 脑瘫上肢功能的疗效[J]. 中国优生与遗传杂志, 2013, 21(4): 150-151.
基金
河南省医学科技攻关计划项目（201304024）。
PDF(1370 KB)
