摘要目的:研究改良Tardieu量表（MTS）与改良Ashworth量表（MAS）评估A型肉毒毒素（BoNT-A）治疗痉挛型脑瘫患儿的响应度。方法:选取2014年12月至2015年5月在广州市妇女儿童医疗中心康复科接受BoNT-A治疗的30例痉挛型脑瘫患儿作为研究对象，男19例，女11例，年龄（78.30±45.50）个月。随机数字表分入BoNT-A联合物理治疗组（B+P组）和单纯物理治疗组（P组），各15例。在BoNT-A注射前1天和注射后2周，应用MTS和MAS评估踝跖屈肌群和肘屈肌群的痉挛程度，采用标准化响应均数（SRM）、Guyatt’s响应指数（GRI）计算MTS、MAS的响应度。结果:两组患儿的一般资料与基线数据比较，差异均无统计学意义（均 P＞0.05）。评估踝跖屈肌群痉挛时，MTS（SRM=0.86～3.17，GRI=0.56～4.93）和MAS（SRM=1.11～1.26，GRI=1.52～1.84）指标均有中等至较高的响应度；评估肘屈肌群痉挛时，MTS的肌肉反应角度Y、快牵角度R1（SRM=7.21，GRI=7.59～9.80）、MAS（SRM=1.09，GRI=1.59）亦有较高的响应度，但MTS的肌肉反应性X、快牵角度R1只有很低的响应度（SRM=0.10，GRI=0.10）。 结论:MTS和MAS均能较好地检测BoNT-A注射后痉挛型脑瘫患儿肢体痉挛的变化，其中MTS快牵角度R1在随机对照研究中有最高的响应度，提示其可能是评估痉挛的首选指标。

abstractsObjective:To study Modified Tardieu Scale versus Modified Ashworth Scale in assessing the responsiveness of botulinum neurotoxin A for children with spastic cerebral palsy.Methods:Thirty (78.30±45.50) months old children (19 boys and 11 girls) with spastic cerebral palsy treated at Department of Rehabilitation, Guangzhou Women and Children's Medical Center from December, 2014 to May, 2015 were randomly assigned to a botulinum neurotoxin A intervention and physical therapy group (group B+P) and a physical therapy group (group P), with 15 cases in each group. One day before and two weeks after botulinum neurotoxin A intervention, Modified Tardieu Scale and Modified Ashworth Scale were used to test the spasticity of ankle plantar and elbow flexors. The responsiveness of the two scales was compared with standardized response mean (SRM=average change in Group B+P/SD of change in group B+P) and Guyatt's responsiveness index (GRI= average change in Group B+P/SD of change in group P).Results:There were no statistical differences in the general and basic line data between the two groups (all P＞0.05). When measuring the spasticity of ankle plantar flexors, both Modified Tardieu Scale (SRM=0.86-3.17, GRI=0.56-4.93) and Modified Ashworth Scale (SRM=1.11-1.26, GRI=1.52-1.84) showed higher responsiveness. When elbow flexor spasticity was assessed, the spasticity angle Y and the fast stretch angle R1 of Modified Tardieu Scale (SRM=7.21, GRI=7.59-9.80) and Modified Ashworth Scale (SRM=1.09, GRI=1.59) showed high responsiveness, but the spasticity angle X and the fast stretch angle R1 of Modified Tardieu Scale got low responsiveness (SRM=0.10, GRI=0.10). Conclusions:Both Modified Tardieu Scale and Modified Ashworth Scale show high responsiveness in assessing the spasticity of children with spastic cerebral palsy to botulinum neurotoxin A intervention. In particular, the fast stretch angle R1 of Modified Tardieu Scale might be the best component for accessing the spasticity reduction, as it shows the highest value.