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中华妇幼临床医学杂志(电子版) ›› 2021, Vol. 17 ›› Issue (02) : 190 -197. doi: 10.3877/cma.j.issn.1673-5250.2021.02.010

所属专题： 文献；

论著

A型肉毒毒素联合悬吊运动训练治疗痉挛型脑性瘫痪患儿的疗效及其对运动功能的影响
董文旭, 童光磊†(), 李红, 蔡云飞, 王萍   
  • 收稿日期:2020-10-13 修回日期:2021-03-12 出版日期:2021-04-01
  • 通信作者: 童光磊

Botulinum toxin type A combined with sling exercise training in treatment of spastic cerebral palsy and its effect on motor functions

Wenxu Dong, Guanglei Tong†(), Hong Li, Yunfei Cai, Ping Wang   

  • Received:2020-10-13 Revised:2021-03-12 Published:2021-04-01
  • Corresponding author: Guanglei Tong
  • Supported by:
    Project of Anhui Provincial Health and Family Planning Commission(2017ek006); Young and Middle-aged General Project of Anhui Provincial Children′s Hospital(19etyy002); Research Public Welfare Linkage Project of Anhui Science Technology Committee(1604f0804007)
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引用本文：

董文旭, 童光磊, 李红, 蔡云飞, 王萍. A型肉毒毒素联合悬吊运动训练治疗痉挛型脑性瘫痪患儿的疗效及其对运动功能的影响[J]. 中华妇幼临床医学杂志(电子版), 2021, 17(02): 190-197.

Wenxu Dong, Guanglei Tong, Hong Li, Yunfei Cai, Ping Wang. Botulinum toxin type A combined with sling exercise training in treatment of spastic cerebral palsy and its effect on motor functions[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2021, 17(02): 190-197.

目的

探讨A型肉毒毒素(BTX-A)联合悬吊运动训练治疗痉挛型脑性瘫痪(CP)患儿的疗效及其对患儿运动功能影响。

方法

选择2017年3月至2020年7月，安徽省儿童医院收治的62例痉挛型CP患儿为研究对象。采用随机数字表法分别纳入研究组(n＝31)与对照组(n＝31)。2组患儿在接受局部肌内注射BTX-A治疗基础上，对研究组患儿进行悬吊运动训练，而对对照组患儿进行常规康复运动训练，均连续训练干预3个月。采用日常生活活动(ADL)量表评定2组患儿治疗疗效，并采用χ2检验进行比较。2组患儿下肢肌群被动收缩肌电图(双侧内收肌、腘绳肌、腓肠肌)，88项粗大运动功能测试(GMFM88)评分，Berg平衡量表(BBS)评分与关节被动活动度(测量腘窝角、足背屈角的角度)等组间与组内比较，采用成组t检验或配对t检验。本研究遵循的程序符合安徽省儿童医院伦理委员会制定的伦理学标准，并获其批准(审批文号：EYLL-2017-005)。2组患儿性别构成比、年龄、病程、早产儿所占比例等一般临床资料，以及治疗前2组患儿双侧下肢内收肌、腘绳肌及腓肠肌的肌电值，GMFM88、BBS评分，腘窝角、足背屈角比较，差异均无统计学意义(P>0.05)。

结果

①研究组患儿治疗总有效率为87.1%(27/31)，显著高于对照组的64.5%(20/31)，并且差异有统计学意义(χ2＝4.309，P＝0.038)。②2组患儿双侧下肢内收肌、腘绳肌及腓肠肌的肌电值组内比较，治疗后较治疗前均显著下降，研究组患儿治疗后上述肌电值，亦均较对照组显著下降，并且差异均有统计学意义(P<0.05)。③治疗后，研究组患儿GMFM88、BBS评分分别为(65.4±5.9)与(46.9±4.6)分，对照组分别为(58.5±4.9)与(41.2±3.8)分，与组内治疗前的(51.2±3.2)与(36.0±2.9)分、(50.9±3.7)与(36.6±2.6)分比较，均显著增加，并且差异均有统计学意义(研究组：t＝11.621、11.257，均为P<0.001，对照组：t＝6.957、5.491，均为P<0.001)。治疗后，研究组患儿GMFM88、BBS评分均显著高于对照组，并且差异均有统计学意义(t＝5.001、5.387，均为P<0.001)。④治疗后，研究组患儿腘窝角、足背屈角分别为(100.4±12.8)°与(78.0±7.1)°，对照组分别为(96.8±11.5)°与(82.3±9.4)°，与组内治疗前的(91.6±10.1)°与(93.3±10.1)°、(90.8±10.6)°与(94.2±10.4)°比较，均分别显著增大与缩小，并且差异均有统计学意义(研究组：t＝3.023、6.106, P＝0.004、<0.001；对照组：t＝2.143、4.744，P＝0.036、<0.001)。治疗后，研究组患儿腘窝角、足背屈角分别较对照组显著增大与缩小，并且差异均有统计学意义(t＝3.172、2.017，P＝0.003、0.048)。

结论

BTX-A联合悬吊治疗痉挛型CP患儿，疗效较好，有助于患儿运动功能恢复。

关键词: 肉毒杆菌毒素, A型, 悬吊运动训练, 脑性瘫痪, 治疗结果, 运动功能, 运动疗法, 儿童
Objective

To explore effects of botulinum toxin type A (BTX-A) combined with sling exercise training in the treatment of spastic cerebral palsy (CP) and its effect on motor functions.

Methods

A total of 62 children with spastic CP in Anhui Provincial Children′s Hospital from March 2017 to July 2020 were enrolled as research subjects. And they were divided into study group (n=31) and control group (n=31) by random number table method. Children with spastic CP in both groups were treated by local intramuscular-injection of BTX-A. Meanwhile, children in study group were treated by sling exercise training, while children in control group were treated by routine rehabilitation training. The course of treatment was 3 months in two groups. Chi-square test, independent-samples t test and pairwise t test were used for various indexes comparison between two groups, including clinical efficacy, evaluated by activity of daily living (ADL) scale, electromyography of bilateral adductor muscles, hamstring muscles, and gastrocnemius muscles of lower limbs during passive motion, gross motor function measure-88 (GMFM88) score, Berg Balance Scale (BBS) score, and passive range of articular motion (popliteal angle and foot dorsiflexion angle). The procedures followed in this study were conformed to ethical standards established by the Ethics Committee of Anhui Provincial Children′s Hospital and was approved by this committee (Approval No. EYLL-2017-005). The general clinical data such as gender composition ratio, age, disease duration, proportion of preterm infants, as well as electromyography values of bilateral lower adductors, hamstrings and gastrocnemius, GMFM88 and BBS scores, and angles of popliteal and dorsiflexion showed no significant differences between two groups (P>0.05).

Results

①Clinical efficacy of study group was higher than that of control group, and the difference was statistically significant (87.1% vs 64.5%, χ2=4.309, P=0.038). ②After treatment, electromyography values of bilateral lower adductors, hamstrings, and gastrocnemius between two groups were significantly lower than those within each group before treatment, and the above-mentioned electromyography values of children in study group were significantly lower than those of control group after treatment, and all differences were statistically significant (P<0.05). ③After treatment, GMFM88 and BBS scores in study group were (65.4±5.9) and (46.9±4.6) scores, respectively, and in control group were (58.5±4.9) and (41.2±3.8) scores , respectively, both of them were significantly higher than those within each group before treatment (51.2±3.2) and (36.0±2.9) scores, (50.9±3.7) and (36.6±2.6) scores, and all differences were statistically significant (study group: t=11.621, 11.257, P all<0.001; control group: t=6.957, 5.491, P all<0.001). After treatment, scores of GMFM88 and BBS in study group were significantly higher than those in control group, and differences were statistically significant (t=5.001, 5.387, P all<0.001). ④After treatment, popliteal angle was increased in study group and control group, meanwhile, foot dorsiflexion angle was decreased in both groups, and both intra-group comparisons showed statistical differences [study group: (100.4±12.8)° vs (91.6±10.1)°, (78.0±7.1)° vs (93.3±10.1)°, t=3.023, 6.106, P=0.004, <0.001; control group: (96.8±11.5)° vs (90.8±10.6)°, (82.3±9.4)° vs (94.2±10.4)°, t=2.143, 4.744, P=0.036, <0.001). After treatment, study group had significantly larger popliteal angle and lower smaller dorsiflexion angle than those of control group, and both differences were statistically significant (t=3.172, 2.017; P=0.003, 0.048).

Conclusion

Effect of BTX-A combined with sling exercise training in treatment of spastic CP is good, and can effectively promote the recovery of motor functions.

Key words: Botulinum toxin type A, Sling exercise training, Cerebral palsy, Treatment outcome, Motor function, Exercise therapy, Child
表1 2组痉挛型脑性瘫痪患儿治疗疗效比较[例数(%)]
组别 例数 显效 有效 无效 总有效
研究组 31 11(35.5) 16(51.6) 4(12.9) 27(87.1)
对照组 31 8(25.8) 12(38.7) 11(35.5) 20(64.5)
χ2值   — — — 4.309
P值   — — — 0.038
表2 2组痉挛型脑性瘫痪患儿下肢肌群被动收缩肌电图比较(μV，±s)
组别 例数 左侧下肢内收肌 右侧下肢内收肌
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
研究组 31 13.6±0.9 11.8±0.5 -10.211 <0.001 13.5±0.9 11.5±0.3 -11.343 <0.001
对照组 31 13.8±0.9 12.8±0.6 5.322 <0.001 13.6±0.9 12.5±0.6 5.948 <0.001
t值   1.208 7.192     0.619 -7.480    
P值   0.232 <0.001     0.538 <0.001    
组别 例数 左侧下肢腘绳肌 右侧下肢腘绳肌
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
研究组 31 13.8±0.8 11.4±0.4 -14.051 <0.001 13.3±0.7 11.3±0.4 -14.384 <0.001
对照组 31 13.9±0.9 12.5±0.7 6.981 <0.001 13.3±0.6 12.2±0.5 7.865 <0.001
t值   0.737 -7.707     0.298 8.452    
P值   0.464 <0.001     0.767 <0.001    
组别 例数 左侧下肢腓肠肌 右侧下肢腓肠肌
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
研究组 31 15.8±0.9 13.2±0.5 -13.606 <0.001 14.2±0.9 12.2±0.5 -10.657 <0.001
对照组 31 15.7±0.9 14.3±0.8 6.342 <0.001 14.2±0.9 13.1±0.8 4.889 <0.001
t值   0.258 -6.417     0.241 -5.038    
P值   0.797 <0.001     0.810 <0.001    
表3 2组痉挛型脑性瘫痪患儿88项粗大运动功能测试与Berg平衡量表评分比较
组别 例数 GMFM88评分(±s) BBS评分(分，±s)
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
研究组 31 51.2±3.2 65.4±5.9 11.621 <0.001 36.0±2.9 46.9±4.6 11.257 <0.001
对照组 31 50.9±3.7 58.5±4.9 6.957 <0.001 36.6±2.6 41.2±3.8 5.491 <0.001
t值   0.421 5.001     0.896 5.387    
P值   0.675 <0.001     0.374 <0.001    
表4 2组痉挛型脑性瘫痪患儿关节被动活动度比较(°，±s)
组别 例数 腘窝角 足背屈角
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
研究组 31 91.6±10.1 100.4±12.8 3.023 0.004 93.3±10.1 78.0±7.1 6.106 <0.001
对照组 31 90.8±10.6 96.8±11.5 2.143 0.036 94.2±10.4 82.3±9.4 4.744 <0.001
t值   0.290 3.172     0.338 2.017    
P值   0.773 0.003     0.737 0.048    
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