摘要目的 探讨A型肉毒毒素注射联合踝足矫形器治疗脑卒中偏瘫患者下肢痉挛的疗效.方法 采用随机数字表法将103例脑卒中下肢痉挛患者分为对照组、观察组及治疗组,对照组给予常规康复训练,观察组在对照组治疗基础上辅以超声水囊引导下A型肉毒毒素注射,治疗组则在观察组干预基础上辅以踝足矫形器治疗.于治疗前、治疗1个月、3个月及6个月时分别采用临床痉挛指数(CSI)、Fugl-Meyer运动功能量表(FMA)、Berg平衡量表(BBS)及功能独立性评定量表(FIM)对各组患者进行疗效评定.结果 治疗1个月后发现对照组CSI、FMA及FIM评分均较治疗前无明显改善(P＞0.05);治疗组与观察组CSI、FMA及FIM评分均较治疗前明显改善(P＜0.05);治疗3个月及6个月后,发现对照组、观察组CSI评分较治疗1个月时增加,治疗组CSI评分则较治疗1个月时继续降低(P＜0.05);各组患者FMA、FIM评分均较治疗1个月时增加,并且上述指标均以治疗组改善幅度较显著(P＜0.05);观察组CSI、FMA及FIM评分与对照组间差异均无统计学意义(P＞0.05);3组患者BBS评分在治疗1个月、3个月及6个月时均较治疗前持续改善(P＜0.05),并且治疗组BBS评分在上述时间点均显著优于观察组及对照组水平(P＜0.05).结论 超声水囊引导下A型肉毒毒素注射联合踝足矫形器治疗能进一步减轻脑卒中偏瘫患者下肢肌肉痉挛、提高其运动、平衡功能及日常生活活动能力,该联合疗法值得临床推广、应用.

abstractsObjective To investigate the efficacy of botulinum toxin type A injection with ankle-foot orthosis (AFO) for the treatment of post-stroke lower limb spasticity.Methods One hundred and three stroke patients with lower limb spasticity were randomly divided into control group,observation group and treatment group.The patients in control group were given routine treatment,those in observation group were given botulinum toxin type A injection in addition to routine treatment,and those in treatment group were treated with AFO on the basis of the interventions of observation group.Before treatment and at 1,3 and 6 months after treatment,clinic spasticity index (CSI) and Fugl-Meyer assessment (FMA),Berg balance scale (BBS) and functional independence measure (FIM) were used to evaluate the efficacy of all groups.Results When compare the assessment results at 1 month after treatment with those before treatment,statistically significant difference in terms of scores of CSI,FMA and FIM were revealed in treatment group and observation group (P ＜ 0.05),but not in the control group (P ＞ 0.05).Within-group comparison with the results at 1 month after treatment,the scores of CSI at 3 and 6 months increased in control group and observation group,while decreased in treatment group(P ＜ 0.05),although the scores of FMA and FIM increased in all groups and the increase was statistically significant only in treatment group(P ＜ 0.05).Between-group comparison of the scores in CSI,FMA and FIM showed no significant difference between the observation and control groups(P ＞ 0.05).It was shown that the scores of BBS at 1,3,and 6 months improved continuously in all groups(P ＜0.05),the improvements in treatment group were significantly greater than that of observation group and control group (P ＜ 0.05).Conclusion Ultrasound-guided botulinum toxin type A injection with AFO could further improve lower limb muscle spasticity,and enhance motor,balance and activities of daily life for stroke patients.