摘要目的 观察超声定位A型肉毒毒素(BTX-A)注射治疗脑性瘫痪患儿下肢肌肉痉挛的疗效.方法 选择下肢肌肉痉挛的脑性瘫痪患儿75例,分为超声定位BTX-A注射治疗组37例(注射组)和单纯康复治疗组38例(对照组).其中注射组在超声定位后予BTX-A注射患儿下肢痉挛肌群,注射后次日开始进行康复训练.所有患儿在治疗前及治疗2周、1个月、3个月、6个月分别采用改良Ashworth量表(MAS)和粗大运动功能量表(GMFM)行相关评价.结果 注射组在注射2周、1个月、3个月、6个月肌肉痉挛的改善及GMFM评分均优于注射前(P均＜0.01),且痉挛程度在注射2周、1个月改善最明显.注射组治疗效果明显优于对照组(P＜0.05).注射组3个月和6个月MAS评分差异无统计学意义,BTX-A注射有时效性,6个月后可重复注射.结论 采用超声定位BTX-A注射治疗脑性瘫痪患儿下肢肌肉痉挛,定位准确、安全,患儿依从性好,疗效优于单纯康复治疗.

abstractsObjective To evaluate the clinical effect of ultrasonic location botulinum toxin A (BTX-A)injection for lower limbs spasticity in children with cerebral palsy.Methods Seventy-five children with lower limbs spasticity resulting from cerebral palsy were divided into injection group(n =37) and control group(n =38).Ultrasonography was used to located the injection of BTX-A into the spastic muscles of the legs in injection group.Then rehabilitation training was received the day after the injection.For all patients,muscle spasticity and gross motor function measure were evaluated before treatment and in the second week,the first,third and sixth month treatment using the Modified Ashworth Scale(MAS) and the Gross Motor Function Measure(GMFM) assessment.Results In the second week,the first,third and the sixth month of treatment,the improvement of muscle spasticity and GMFM in the injection group were significantly better than before(all P ＜ 0.01).And the improvement of muscle spasticity were the greatest in the second week and the first month of the injection.The average therapeutic effect in the injection group was significantly better than that in the control group(P ＜0.05).There was no statistical difference between the evaluation score of the third month and that of the sixth month for injection group.The BTX-A injection had time limit and could be reinject after 6 months.Conclusions The ultrasound located BTX-A injection to treat lower limbs spasticity in cerebral palsy has the advantages of accurate localization,safety,good child patient compliance and more effective than only rehabilitation treatment.