摘要
目的:观察A型肉毒毒素(botulinum toxin type A,BTX-A)注射联合重复经颅磁刺激(repetitive transcranial magnetic stimulation,r TMS)对脑卒中后下肢肌肉痉挛状态的长期疗效和安全性。方法:共选取80例脑卒中患者,均伴有下肢肌肉痉挛,随机分为常规治疗组、常规治疗+BTX-A治疗组、常规治疗+r TMS治疗组、常规治疗+BTX-A+r TMS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;常规治疗+BTX-A组(B组)的患者除了进行常规康复治疗外,还对下肢痉挛肌肉进行BTX-A注射;常规治疗+r TMS治疗组(C组)则除了常规康复训练,还进行r TMS治疗;而常规治疗+BTX-A+r TMS组(D组)除了进行常规康复治疗及注射BTX-A外,还给予患者r TMS治疗。治疗前和治疗后4周、8周和12周分别进行肌张力、下肢运动功能及ADL能力评定。结果:1肌张力变化情况:4组患者治疗4周后,与治疗前相比,肌张力均有不同程度降低(P<0.05),8周后,A组肌张力有所回升,而B组、C组以及D组未见明显回升;12周时,A组肌张力进一步增加,与此同时,B组也有所回升,而C组与D组仍与8周时无显著差异,同时D组肌张力显著低于其余3组(P<0.05)。2运动及ADL能力变化情况:4组患者治疗4周后,运动功能和ADL能力均有所改善(P<0.05)。8周后,A组患者的运动功能及ADL能力再次出现下降,而其余3组患者未见下降;而12周时,与8周时相比,B组也出现下降,C组与8周时相比无明显变化,而D组则有进一步改善并优于其余3组(P<0.05)。结论:A型肉毒毒素联合重复经颅磁刺激可以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,为临床治疗脑卒中患者提供了新的思路。
Objective： To investigate the effect of botulinum toxin type A （BTX-A） combined with repetitive transcranial magnetic stimulation （rTMS） on spasticity of lower limbs in stroke patients. Method： The stroke patients with spasticity of lower limbs were divided into four groups （n=20）： conventional rehabilitation group （group A）, conventional rehabilitation ＋ BTX-A injection group （group B）, conventional re- habilitation ＋ rTMS group （group C）, conventional rehabilitation ＋ BTX-A injection ＋ rTMS group （group D）. Muscle tone, motor function and activities of daily living （ADL） were evaluated at 4 weeks, 8 weeks and 12 weeks after treatment.Result： ①Muscle tone： After 4 weeks treatment, muscle tone for all groups decreased comparing with those be- fore treatment （P〈 0.05）. After 8 weeks, the muscle tone in group A increased again, while no change in group B, C and D. At 12 weeks, the muscle tone in group A increased further. At the ＂same time, the muscle tone in group B also exhibited a gradually increasing tendency, while no change in group C and D. The mus- cle tone in group D was lower than that of the other three groups. ②Motor function and ADL： Motor func- tion and ADL were ameliorated at 4 weeks after treatment in all groups （P〈 0.05）. After 8 weeks, in group A, the motor function and MBI decreased with no change in group B, C and D, which was similar to the changes of muscle tone. After 12 weeks, the motor function and MBI increase further for group D. Conclusion： These data support that BTX-A combined with rTMS has long-term efficacy for motor function amelioration and the improvement of ADL for stroke patients.
出处
《中国康复医学杂志》
CAS
CSCD
北大核心
2016年第9期936-940,共5页
Chinese Journal of Rehabilitation Medicine
基金
全军"十二五"重点课题(BWS11J003)
国家科技部国际合作项目(2013DFA32610)
国家自然科学基金资助项目(81271450)
关键词
脑卒中
肌痉挛
A型肉毒毒素
重复经颅磁刺激
stroke
spasticity
botulinum toxin type A
repetitive transcranial magnetic stimulation
