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

doi:10.20274/j.cnki.issn.2025.04.007

Abstract

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

CLC Number:

R742.3

Zengquan ZHONG, Xue JIANG, Shuangquan SUN, Yiming LI, Wei LI, Xin ZHANG, Hong LI, Zhihai LYU. Efficacy and follow-up of ultrasound-guided botulinum toxin type A injection for lower limb spasticity in cerebral palsy[J]. Chinese Pediatrics of Integrated Traditional and Western Medicine, 2025, 17(4): 313-319.

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References 18

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组别	n	小腿三头肌				F值	P值
组别	n	干预前	干预后1个月	干预后6个月	干预后12个月	F值	P值
对照组	35	3.12±0.49	2.51±0.73	1.98±0.69	1.79±0.81	25.417	<0.001
观察组	34	3.23±0.61	1.99±0.34	1.56±0.44	1.29±0.57	52.831	<0.001
t值		-0.824	3.810	3.021	2.974
P值		0.410	<0.001	0.002	0.003
组别	n	腘绳肌				F值	P值
组别	n	干预前	干预后1个月	干预后6个月	干预后12个月	F值	P值
对照组	35	2.94±0.67	2.58±0.51	1.86±0.43	1.54±0.52	31.645	<0.001
观察组	34	3.01±0.63	2.26±0.72	1.49±0.68	1.17±0.57	45.219	<0.001
t值		-0.447	2.124	2.692	2.817
P值		0.656	0.034	0.007	0.005

组别	n	D区				F值	P值
组别	n	干预前	干预后1个月	干预后6个月	干预后12个月	F值	P值
对照组	35	24.63±2.15	28.46±3.05	34.91±4.22	36.16±3.74	78.332	<0.001
观察组	34	23.80±3.75	32.52±2.49	36.99±2.58	38.12±2.22	112.645	<0.001
t值		1.124	-6.064	-2.477	-2.657
P值		0.262	<0.001	0.013	0.008
组别	n	E区				F值	P值
组别	n	干预前	干预后1个月	干预后6个月	干预后12个月	F值	P值
对照组	35	22.81±5.09	31.57±6.17	44.29±5.29	49.99±4.25	142.771	<0.001
观察组	34	23.05±5.55	38.97±4.57	48.79±3.66	54.62±6.04	189.324	<0.001
t值		-0.187	-5.673	-4.115	-3.673
P值		0.852	<0.001	<0.001	<0.001

组别	n	干预前				干预后12个月				Z值	P值
组别	n	Ⅰ	Ⅱ	Ⅲ	Ⅳ	Ⅰ	Ⅱ	Ⅲ	Ⅳ	Z值	P值
对照组	35	0	7	20	8	4	7	18	6	-5.42	<0.001
观察组	34	0	7	18	9	8	15	8	3	-5.78	<0.001
Z值		-0.193				-2.653
P值		0.847				0.008

组别	n	干预前	干预后1个月	干预后6个月	干预后12个月	F值	P值
对照组	35	49.16±8.21	59.66±6.59	70.22±7.11	78.16±5.83	158.332	<0.001
观察组	34	50.02±9.13	63.12±7.12	78.54±6.22	85.64±7.01	221.745	<0.001
t值		-0.411	-2.092	-5.175	-4.814
P值		0.681	0.037	<0.001	<0.001

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

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