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目的通过向脑卒中上肢痉挛患者注射A型肉毒毒素(BTXA),以探讨A型肉毒毒素对其上肢肌肉痉挛及活动功能的影响。方法共选取32例脑卒中患者,其偏瘫侧上肢屈肌痉挛Ashworth评级为2～3级,将其随机分为治疗组及对照组。治疗组患者选择肱二头肌、前臂屈肌群注射A型肉毒毒素,随后进行康复训练;对照组患者未给予A型肉毒毒素注射,仅单纯进行康复训练。于治疗前、治疗后1周、2周、6周及12周时进行疗效评定,疗效评定指标包括改良Ashworth痉挛量表评分、Fugl-Meyer上肢功能检测及Barthel指数评分。结果治疗组患者治疗后各观察时间点偏瘫侧上肢肌痉挛情况较治疗前明显降低,肌痉挛改善幅度以治疗后第2周时最为显著,随后改善幅度有所减缓,但与治疗前比较,差异仍有统计学意义(P<0.05),疗效一直持续至治疗后第12周;同时治疗组患者Fugl-Meyer评分、Barthel指数评分也较治疗前明显改善,并且与对照组各相应疗效指标间差异均有统计学意义(P<0.05)。结论A型肉毒毒素可显著降低脑卒中患者痉挛上肢肌张力,并对改善患肢活动功能及日常生活活动能力具有明显促进作用,其疗效至少持续12周左右。
Objective To investigate the effect of botulinum toxin type A on the muscle spasm and motor function of upper extremity by injecting botulinum neurotoxin type A (BTXA) into patients with spastic upper limbs. Methods A total of 32 stroke patients were selected. The Ashworth grade of upper limb flexor muscle in grade 2 and 3 was randomly divided into treatment group and control group. In the treatment group, the biceps and forearm flexor muscle groups were injected with botulinum toxin type A, followed by rehabilitation training. In the control group, botulinum toxin type A injection was not given and only rehabilitation training was performed. The curative effect was evaluated before treatment, 1 week, 2 weeks, 6 weeks and 12 weeks after treatment. The evaluation indexes included improved Ashworth’s Spasm Scale, Fugl-Meyer upper limb function test and Barthel Index score. Results In the treatment group, the spasticity of the upper extremity muscles on the hemiparetic side was significantly lower than that before treatment at each observation time point after treatment. The extent of improvement of muscle spasm was the most significant at the second week after treatment, and then the rate of improvement was slowed down. However, compared with that before treatment, (P <0.05). The curative effect lasted until the twelfth week after treatment. At the same time, Fugl-Meyer score and Barthel index score in the treatment group were also significantly improved compared with those before treatment, and there was significant difference between the two groups All were statistically significant (P <0.05). Conclusion Botulinum toxin type A can significantly reduce the muscle tension of spastic upper limbs in patients with stroke, and significantly improve the activities of limbs and activities of daily living. The efficacy of botulinum toxin type A persists for at least 12 weeks.