应用A型肉毒毒素注射结合痉挛肌电刺激治疗脑卒中后下肢肌痉挛的研究

王环芬; 刘薇; 陈赛亚; 陈美兰

doi:10.16766/j.cnki.issn.1674-4152.003390

应用A型肉毒毒素注射结合痉挛肌电刺激治疗脑卒中后下肢肌痉挛的研究

doi: 10.16766/j.cnki.issn.1674-4152.003390

温州市中医院老年医学科，浙江温州 325000

基金项目:

浙江省医药卫生科技计划项目 2023KY1159

详细信息

通讯作者:
王环芬，E-mail：whf88672022@163.com

中图分类号: R743.3 R454.1
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- 文章访问数: 278
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- 被引次数: 0
出版历程
- 收稿日期: 2023-10-12
- 网络出版日期: 2024-03-27

Study on the treatment of lower limb muscle spasms after stroke using botulinum toxin A injection combined with spasmodic electromyography stimulation

Department of Geriatrics, Wenzhou Traditional Chinese Medicine Hospital, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的为拓展脑卒中后肌痉挛的治疗方案，提高脑卒中患者生存质量，探讨A型肉毒毒素注射结合痉挛肌电刺激治疗脑卒中后下肢肌痉挛的临床效果。方法选取2020年2月—2023年2月温州市中医院收治的140例脑卒中后下肢肌痉挛患者为研究对象，按随机数字表法分为观察组(70例)和对照组(70例)，所有患者均进行康复训练，对照组实施A型肉毒毒素注射治疗，观察组增加痉挛肌电刺激治疗。分别于干预前后评价患者下肢肌痉挛疗效水平，测定下肢肌电运动单位动作电位(MUAP)数目，评价运动功能和生活能力水平，检测腓肠肌超声指标变化。结果观察组下肢肌痉挛治疗总有效率(94.29%，66/70)高于对照组(81.43%，57/70，χ²=5.423, P=0.020)；观察组干预后小腿三头肌MUAP数目(10.92±1.74)显著少于对照组(14.86±1.85，t=12.979, P < 0.001)；观察组干预后Fugl-Meyer量表(FMA)、功能性步行能力量表(FAC)和改良Barthel指数量表(MBI)评分均高于对照组(P < 0.001)；观察组干预后下肢腓肠肌羽状角度(PA)低于对照组，而肌纤维长度(FL)和肌纤维厚度(MT)均高于对照组(P < 0.001)。结论 A型肉毒毒素注射结合痉挛肌电刺激有助于提高脑卒中后下肢肌痉挛疗效水平，缓解下肢肌痉挛程度，促进患肢肌肉结构及功能恢复，改善患者运动能力和生存质量。
- 脑卒中 /
- 下肢肌痉挛 /
- 康复训练 /
- 痉挛肌电刺激 /
- A型肉毒毒素
Abstract: Objective To enhance the treatment options for post-stroke muscle spasms and improve the quality of life of stroke patients, the clinical effect of combining botulinum toxin A injection with spasmodic electromyography stimulation for the rehabilitation of post-stroke lower limb muscle spasms were explored. Methods A total of 140 patients with lower limb muscle spasms after stroke who were admitted to Wenzhou Traditional Chinese Medicine Hospital between February 2020 and February 2023 were enrolled. The 70 cases in the observation group and the 70 cases in the control group were randomly divided into two groups using a random number table method. All patients underwent rehabilitation training, The control group received injection of type A botulinum toxin, while the observation group received additional treatment with spasmodic electromyographic stimulation. The study evaluated the therapeutic effect of interventions on lower limb muscle spasms in patients, comparing the levels before and after the intervention. The lower limb muscle ' s motor unit action potential (MUAP) count was measured. The study evaluated the level of motor function and living ability, as well as changes in ultrasonic indexes of gastrocnemius muscle structure. Results The research group achieved a significantly higher overall effective rate of lower limb muscle spasm treatment (94.29%, 66/70) compared to the control group (81.43%, 57/70), χ²=5.423, P=0.020. Following the intervention, the number of MUAP in the triceps surae of the observation group (10.92±1.74) was significantly lower than that of the control group (14.86±1.85, t=12.979, P < 0.001). Following the intervention, the scores for Fugl-Meyer assessment scale (FMA), functional ambulation category scale (FAC), and modified Barthel index (MBI) were significantly higher in the observation group than in the control group (P < 0.001). Following the intervention, the observation group exhibited lower PA and MT values of in the lower limb gastrocnemius muscle compared to the control group. Conversely, the FL and MT values were higher in the observation group than in the control group (P < 0.001). Conclusion The combination of spastic myoelectric stimulation and botulinum toxin A therapy can enhance the therapeutic effect of lower limb muscle spasms after stroke. It can also alleviate the severity of lower limb muscle spasms, promote the recovery of affected limb muscle structure and function, and improve patients ' motor ability and quality of life.
- Stroke /
- Lower limb muscle spasm /
- Rehabilitation training /
- Spastic electromyographic stimulation /
- Botulinum toxin A

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表 1 2组卒中后下肢肌痉挛患者一般资料比较

Table 1. Comparison of general data between the two groups of patients with post-stroke lower limb muscle spasticity

组别	例数	性别(例)		年龄 (x±s，岁)	脑卒中类型(例)		病程 (x±s，月)	偏瘫侧别(例)		MAS分级(例)
组别	例数	男性	女性	年龄 (x±s，岁)	脑梗死	脑出血	病程 (x±s，月)	左侧	右侧	Ⅱ级	Ⅲ级	Ⅳ级
观察组	70	36	34	57.68±6.72	49	21	3.84±1.27	35	35	39	23	8
对照组	70	33	37	57.93±6.85	47	23	3.71±1.32	37	33	40	24	6
统计量		0.257^a		0.218^b	0.133^a		0.594^b	0.114^a		0.320^a
P值		0.612		0.828	0.716		0.554	0.735		0.852
注：^a为χ²值，^b为t值。

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表 2 2组卒中后下肢肌痉挛患者下肢肌痉挛治疗总有效率比较[例(%)]

Table 2. Comparison of efficacy level of lower limb muscle spasticity in patients with post-stroke lower limb muscle spasticity after stroke between the two groups [cases (%)]

组别	例数	显效	有效	无效	总有效
观察组	70	27(38.57)	39(55.71)	4(5.71)	66(94.29)
对照组	70	16(22.86)	41(58.57)	13(18.57)	57(81.43)
注：2组总有效率比较，χ²=5.423，P=0.020。

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表 3 2组卒中后下肢肌痉挛患者干预前后小腿三头肌MUAP数目比较(x±s)

Table 3. Comparison of MUAP number of triceps calf muscle before and after intervention in two groups of patients with post-stroke lower limb muscle spasticity (x±s)

组别	例数	干预前	干预3个月后	t值	P值
观察组	70	21.84±2.59	10.92±1.74	-16.258	< 0.001
对照组	70	21.39±2.41	14.86±1.85	-24.736	< 0.001
t值		1.064	12.979
P值		0.289	< 0.001

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表 4 2组卒中后下肢肌痉挛患者干预前后FMA、FAC和MBI评分比较(x±s，分)

Table 4. Comparison of FMA, FAC and MBI scores between the two groups of patients with post-stroke lower limb muscle spasm before and after intervention (x±s, points)

组别	例数	FMA		FAC		MBI
组别	例数	干预前	干预3个月后	干预前	干预3个月后	干预前	干预3个月后
观察组	70	16.81±1.97	25.03±2.76^a	10.35±1.25	21.84±2.43^a	22.47±3.06	63.45±6.28^a
对照组	70	16.49±1.86	21.27±2.28^a	10.67±1.18	18.92±2.19^a	22.05±2.94	56.73±5.91^a
t值		0.988	8.787	1.558	7.468	0.845	6.520
P值		0.325	< 0.001	0.122	< 0.001	0.399	< 0.001
注：与同组干预前比较，^aP < 0.05。

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表 5 2组卒中后下肢肌痉挛患者干预前后腓肠肌结构超声指标比较(x±s)

Table 5. Comparison of gastrocnemius structural ultrasound indexes before and after intervention in two groups of patients with post-stroke lower limb muscle spasticity (x±s)

组别	例数	PA(°)		FL(mm)		MT(mm)
组别	例数	干预前	干预3个月后	干预前	干预3个月后	干预前	干预3个月后
观察组	70	16.72±1.59	11.46±1.35^a	34.29±3.28	43.72±4.86^a	9.75±1.06	12.41±1.42^a
对照组	70	16.45±1.61	13.59±1.41^a	33.86±3.41	39.68±4.21^a	9.49±1.18	10.84±1.31^a
t值		0.998	9.129	0.760	5.257	1.371	6.924
P值		0.320	< 0.001	0.448	< 0.001	0.173	< 0.001
注：与同组干预前比较，^aP < 0.05。

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