本文選題：腦性癱瘓 + 肉毒桿菌毒素類　； 參考：《中國(guó)全科醫(yī)學(xué)》2017年31期

【摘要】：目的探討A型肉毒毒素(BTX-A)注射聯(lián)合功能訓(xùn)練對(duì)痙攣型腦癱(SCP)患兒尖足畸形、粗大運(yùn)動(dòng)功能及智力發(fā)育的影響。方法選取2012年4月—2015年10月河南省中醫(yī)院收治的SCP患兒66例。按照隨機(jī)數(shù)字表法將患者分為對(duì)照組(n=33)和觀察組(n=33)。對(duì)照組予以功能訓(xùn)練,包括被動(dòng)關(guān)節(jié)活動(dòng)度訓(xùn)練、肌力訓(xùn)練、步行訓(xùn)練;觀察組在對(duì)照組的基礎(chǔ)上接受BTX-A注射治療。于治療前和治療后3個(gè)月,觀察和比較兩組患兒的下肢痙攣程度、踝關(guān)節(jié)被動(dòng)背屈角度、粗大運(yùn)動(dòng)功能發(fā)育情況、智力發(fā)育水平、日常生活活動(dòng)能力(ADL),并觀察治療過(guò)程中的不良反應(yīng)。結(jié)果 (1)下肢痙攣程度:兩組治療前后綜合痙攣量表(CSS)評(píng)分差值比較,差異有統(tǒng)計(jì)學(xué)意義(t=4.388,P0.01)。(2)踝關(guān)節(jié)被動(dòng)背屈角度:兩組治療前后左足背屈角度、右足背屈角度差值比較,差異均有統(tǒng)計(jì)學(xué)意義(t值分別為3.937、3.060,P0.01)。(3)粗大運(yùn)動(dòng)功能發(fā)育情況:兩組治療前后粗大運(yùn)動(dòng)功能量表(GMFM)的D、E區(qū)評(píng)分差值比較,差異均有統(tǒng)計(jì)學(xué)意義(t值分別為17.207、7.559,P0.01)。(4)智力發(fā)育水平:兩組治療前后嬰幼兒智力發(fā)育量表(CDCC)的智力發(fā)育指數(shù)(MDI)和心理運(yùn)動(dòng)發(fā)育指數(shù)(PDI)差值比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(t值分別為1.733、1.746,P0.05)。(5)ADL評(píng)分:兩組治療前后ADL評(píng)分差值比較,差異有統(tǒng)計(jì)學(xué)意義(t=6.792,P0.01)。(6)不良反應(yīng):兩組患者均未發(fā)生明顯的不良反應(yīng)。結(jié)論 BTX-A注射聯(lián)合功能訓(xùn)練能有效改善SCP患兒尖足畸形和粗大運(yùn)動(dòng)功能,不會(huì)對(duì)智力發(fā)育產(chǎn)生影響,并能提高患兒ADL。
[Abstract]:Objective to investigate the effects of botulinum toxin A (BTX-A) injection combined with functional training on apical foot deformity, coarse motor function and intellectual development in children with spastic cerebral palsy (SCP). Methods 66 cases of SCP were selected from April 2012 to October 2015 in Henan traditional Chinese Medicine Hospital. Patients were divided into control group and observation group according to random number table. The control group received functional training, including passive joint movement training, muscle strength training and walking training, while the observation group received BTX-A injection therapy on the basis of the control group. Before and 3 months after treatment, the degree of spasm of lower extremity, the angle of passive dorsiflexion of ankle joint, the development of coarse motor function and the level of intellectual development were observed and compared between the two groups. ADL activity and adverse reactions during treatment were observed. Results (1) the degree of spasticity of lower extremity: the difference of CSS score before and after treatment was statistically significant (P < 0.05). The angle of passive dorsiflexion of ankle joint: the angle of left foot flexion and the angle difference of right foot flexion before and after treatment were compared between the two groups. There were significant differences in the development of gross motor function between the two groups (3.937 / 3.060,3.060). The difference of the DNE score between the two groups before and after treatment was compared, and the difference between the two groups before and after treatment was analyzed. The difference was statistically significant (P < 0.01). The difference of mental development index (MDI) and psychomotor development index (PDI) between the two groups were compared before and after treatment. There was no significant difference between the two groups. The difference of ADL scores before and after treatment was statistically significant. There were no significant adverse reactions between the two groups. There were no significant adverse reactions in the two groups. Conclusion BTX-A injection combined with functional training can effectively improve the apical foot deformity and coarse motor function of SCP children, and can not affect the intelligence development, and can improve the ADL of children with SCP.
【作者單位】： 河南省中醫(yī)院兒童腦病康復(fù)科;
【基金】：河南省高等學(xué)校重點(diǎn)科研計(jì)劃項(xiàng)目(15A360003)
【分類號(hào)】：R742.3

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