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王 虹,赵晨光,袁 华,刘 卫,袁鸿儒,惠 楠,牟 翔.A型肉毒毒素联合冲击波疗法对脑卒中后下肢痉挛状态的疗效观察[J].中国康复医学杂志,2017,(7):773~778
A型肉毒毒素联合冲击波疗法对脑卒中后下肢痉挛状态的疗效观察    点此下载全文
王 虹  赵晨光  袁 华  刘 卫  袁鸿儒  惠 楠  牟 翔
第四军医大学附属西京医院,陕西西安,710032
基金项目:国家科技部国际合作项目(2013DFA32610);国家自然科学基金项目(81271450);陕西省国际合作与交流项目(2015KW-035)
DOI:
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摘要:
      摘要 目的:观察A型肉毒毒素(BTX-A)注射联合体外冲击波疗法(ESWT)对脑卒中后下肢肌肉痉挛状态的疗效和安全性。 方法:共选取60例脑卒中患者,均伴有下肢肌肉痉挛(小腿三头肌痉挛为主),随机分为常规治疗组、常规治疗+BTX-A治疗组、常规治疗+BTX-A +ESWT治疗组,每组各20例患者。常规治疗组(A组)采用各种常规康复训练方法,每日1次,每周6次,共治疗4周;常规治疗+BTX-A组(B组)的患者除了进行常规康复治疗外,还对小腿痉挛肌肉进行BTX-A注射;而常规治疗+BTX-A +ESWT组(C组)除了进行常规康复治疗及局部注射BTX-A外,还给予患者小腿三头肌进行EWST治疗,每周1次,治疗4周。治疗前和治疗后1周、4周和16周分别进行踝关节跖屈肌群肌张力、下肢运动功能以及日常生活活动(ADL)能力评定。 结果:①肌张力变化情况:三组患者治疗1周后,与治疗前相比,A组和B组略有下降、但是C组肌张力显著性降低(P<0.05)。4周后,A、B、C组肌张力均显著性下降(P<0.05),而B组、C组较A组效果更为佳(P<0.05)。16周随访,A、B、C组肌张力均有所回升,但B、C组肌张力较治疗前仍降低(P<0.05),且C组优于B组(P<0.05)。②运动及ADL能力变化情况:三组患者治疗1周后,A、B、C组患者的运动功能及ADL能力无明显改善;4周后,三组运动功能和ADL能力均有所改善(P<0.05),B组、C组改善较A组更好(P<0.05)。而16周时,A组、B组运动功能和ADL能力出现下降,B组、C组相比虽有下降,但仍优于A组(P<0.05)。 结论:A型肉毒毒素联合冲击波疗法可以迅速并且较持久地降低患者肌张力,也能够有效地提高患者的运动功能和ADL能力,对脑卒中后肢体痉挛有明显改善作用。
关键词:脑卒中  痉挛状态  A型肉毒毒素  体外冲击波疗法
The effect of botulinum toxin type A combined with extracorporeal shock wave therapy on spasticity of lower limbs in stroke patients    Download Fulltext
Xijing Hospital,the Fourth Military Medical University, Xi'an, Shanxi, 710032
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Abstract:
      Abstract Objective: To observe the efficacy and safety of botulinum toxin type A (BTX-A) injection combined with extracorporeal shock wave therapy (ESWT) in the treatment of lower limb muscle spasm after stroke. Method: A total of 60 stroke patients associated with lower extremity muscle spasms (triceps spasm) were enrolled in this study, and were randomly divided into routine treatment group, routine treatment+BTX-A treatment group and routine treatment+BTX-A+ESWT treatment group, with 20 patients in each group. The routine treatment group (group A) was given various conventional methods of rehabilitation training(1 times a day, 6 times a week, a total of 4 weeks of treatment), conventional treatment +BTX-A group (group B) the patients were given conventional rehabilitation treatment and BTX-A injection on muscle and leg cramps as well,routine treatment +BTX-A +ESWT group (group C) were given routine rehabilitation therapy, local injection of BTX-A and triceps EWST treatment(1 times a week for 4 weeks). Muscle tension, function of movement in lower limb and activity of daily life (ADL) were assessed at the 1st week, 4st week and 16st week after treatment. Result: ①After 1 week of treatment, group A and B had no obvious changes, while the degree of muscle tension in groups C decreased significantly (P<0.05). After 4 weeks, muscle tension of all three groups decreased (P<0.05). Group B and group C had better results than group A (P<0.05). After 16 weeks follow-up, three groups of muscle tension all increased, but the muscle tension in group B and group C is still lower than the other two groups (P<0.05), and group C is better than group B (P<0.05).②After 1 weeks of treatment, function of movement and activity of daily life in the three groups had no obvious improvement. After 4 weeks of treatment, function of movement and activity of daily life in three groups were improved (P<0.05) with more significant improvement in group B and group C (P<0.05) . After 16 weeks of treatment, function of movement and activity of daily life in all three groups decreased, but group B and group C is still better than group A (P<0.05). Conclusion: Botulinum toxin type A combined with extracorporeal shock wave therapy had rapid and more lasting effects on spasticity of lower limbs in stroke patients. It can effectively improve the patient's motor function and activity of daily life, and decrease the limb spasm after stroke.
Keywords:stroke  spasticity  botulinum toxin type A  extracorporeal shock wave therapy
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