ISSN 1674-3865  CN 21-1569/R
主管：国家卫生健康委员会
主办：中国医师协会
　　　辽宁省基础医学研究所
　　　辽宁中医药大学附属医院
中国中西医结合儿科学

中国中西医结合儿科学 ›› 2025, Vol. 17 ›› Issue (4): 313-319.doi: 10.20274/j.cnki.issn.2025.04.007

• 临床研究 • 上一篇    下一篇

超声引导下A型肉毒毒素注射治疗脑性瘫痪下肢痉挛的疗效和随访研究

钟增泉1, 姜雪1, 孙双全2, 李翌鸣1, 李威1, 张欣3, 历虹3, 吕智海1()   

  1. 518172 广东 深圳，深圳市龙岗区妇幼保健院（汕头大学医学院龙岗妇幼临床学院）儿童康复科（钟增泉，姜雪，李翌鸣，李威，吕智海）
    150010 哈尔滨，哈尔滨医科大学附属第六医院/哈尔滨市儿童医院儿童康复科（孙双全）
    150026 哈尔滨，黑龙江省第六医院儿童康复科（张欣，历虹）
  • 收稿日期:2025-02-14 修回日期:2025-04-25 出版日期:2025-08-25 上线日期:2025-08-25
  • 通讯作者: 吕智海 E-mail:13613602038@163.com
  • 作者简介:钟增泉（1985-），男，主管技师。研究方向：高危儿脑损伤的综合防治
  • 基金资助:
    2022年度黑龙江省卫生健康委科技计划项目(20222020010975);深圳市龙岗区医疗卫生科技计划项目(LGWJ2021-68);深圳市龙岗区医学重点学科建设项目

Efficacy and follow-up of ultrasound-guided botulinum toxin type A injection for lower limb spasticity in cerebral palsy

Zengquan ZHONG1, Xue JIANG1, Shuangquan SUN2, Yiming LI1, Wei LI1, Xin ZHANG3, Hong LI3, Zhihai LYU1()   

  1. 1.Longgang District Maternity&Child Healthcare Hospital of Shenzhen City（Longgang Maternity and Child Institute of Shantou University Medical College）, Shenzhen 518172, China
    2.Harbin Children's Hospital(The Sixth Affiliated Hospital of Harbin Medical University), Harbin 150010，China
    3.Heilongjiang Province Sixth Hospital, Harbin 150026，China
  • Received:2025-02-14 Revised:2025-04-25 Published:2025-08-25 Online:2025-08-25
  • Contact: Zhihai LYU E-mail:13613602038@163.com
  • Supported by:
    The Science and Technology Program of Heilongjiang Provincial Health Commission

RichHTML

0

PDF (PC)

2

摘要：

目的 探讨超声引导下A型肉毒毒素（BTX-A）注射联合常规康复训练治疗脑性瘫痪（简称脑瘫）儿童下肢痉挛的临床疗效。 方法 选择2017年6月至2022年3月哈尔滨市儿童医院与深圳市龙岗区妇幼保健院收治的痉挛型脑瘫患儿69例为研究对象，随机分为对照组35例和观察组34例。所有受试者接受标准化康复方案：（1）基础运动功能重建（基于任务导向性训练理论框架设计，每次30 min）；（2）软组织状态改善（蜡饼热敷治疗，温度52～55 ℃，每次30 min）；（3）神经肌肉调控（低频电刺激治疗，频率1 Hz，脉宽100 ms）。观察组在以上治疗基础上接受精准定位注射治疗：采用超声影像定位技术实时引导下，根据病情需要于腓肠肌（４～６ IU/kg），比目鱼肌、半腱肌、半膜肌（１～２ IU/kg）注射BTX-A（稀释浓度50 IU/mL）。系统治疗周期设定为6个月，其中注射干预在第0个月首次评估后完成。评估方法在基线期、治疗1个月、6个月以及12个月后随访时，由双盲评估团队通过：（1）肌肉张力动态评估：改良Tardieu量表（MTS）测量0°、V3速度下关节活动度；（2）运动功能进展：粗大运动功能测试量表（GMFM）维度D、E区评分；（3）生活参与度：儿童功能独立性评定量表(WeeFIM)进行量化分析。 结果 治疗1个月、6个月及12个月后，两组痉挛型脑瘫儿童的粗大运动功能分级与MTS评分均呈进行性降低，差异有统计学意义（P<0.05），GMFM与WeeFIM则呈进行性增高，差异有统计学意义（P<0.05）。治疗后1个月、6个月与12个月后观察组MTS评分较同期对照组显著降低，差异有统计学意义（P<0.05），GMFM与WeeFIM评分则较同期对照组显著增高，差异有统计学意义（P<0.05）。 结论 对于痉挛型脑瘫儿童，超声引导下注射BTX-A用于缓解其下肢痉挛是可行的，对其后期肌肉功能、粗大运动功能以及功能独立性的改善是有效的，该联合疗法值得临床推广与应用。

关键词: 脑性瘫痪, 痉挛, A型肉毒毒素, 粗大运动功能, 儿童

Abstract:

Objective To investigate the clinical efficacy of ultrasound-guided botulinum toxin type A(BTX-A) injection combined with conventional rehabilitation training in the treatment of lower limb spasticity in children with cerebral palsy (CP). Methods A total of 69 children with spastic CP who were admitted to Harbin Children's Hospital (The Sixth Affiliated Hospital of HMU) and Longgang District Maternal and Child Health Hospital of Shenzhen between June 2017 and March 2022 were randomized into a control group(n=35) and an observation group(n=34).All participants received a standardized rehabilitation protocol:(1)basic motor function reconstruction (task-oriented training, 30 min/session);(2) soft tissue management (wax therapy at 52-55 ℃, 30 min/session);(3)neuromuscular modulation(low-frequency electrical stimulation at 1 Hz, pulse width 100 ms).The observation group additionally received precise positioning injection: ultrasound-guided BTX-A injection (dilution: 50 IU/mL) was performed at gastrocnemius (4–6 IU/kg), and at soleus, semitendinosus and semimembranosus (1–2 IU/kg) based on disease condition. The systematic treatment lasted for 6 months as a course, and the injection was completed at 0 month after the first assessment. Outcomes were assessed by double-blinded assessment team during the follow-ups at baseline, and after 1, 6, and 12 months of treatment through:(1)dynamic assessment of muscular tension using modified Tardieu scale(MTS) to measure the range of motion at 0°and V3 velocity;(2)progress in motor function using gross motor function measurement(GMFM) to score the dimensions D/E;(3)life participation using functional independence measurement for children(WeeFIM) to make quantitative analysis. Results Both groups showed progressive decrease in MTS scores and gross motor function classification system(GMFCS) levels(P<0.05), and progressive increase in GMFM and WeeFIM scores(P<0.05) after 1, 6, and 12 months of treatment. The observation group demonstrated significantly lower MTS scores(P<0.05) and significantly higher GMFM/WeeFIM scores(P<0.05) than the control group at all post-treatment intervals. Conclusions Ultrasound-guided BTX-A injection is feasible for alleviating lower limb spasticity in children with spastic CP, which effectively improves muscle function, gross motor function, and functional independence, so this combined therapy is worthy of clinical promotion and application.

Key words: Cerebral palsy, Spasticity, Botulinum toxin type A, Gross motor function, Child

中图分类号: