A型肉毒毒素对偏瘫上肢Brunnstrom运动恢复阶段的影响
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摘要
目的：评价A型肉毒毒素结合康复治疗对脑卒中后偏瘫上肢Brunnstrom运动恢复阶段及对日常生活活动能力的影响。方法：选取脑卒中患者30例，随机分为BTXA组和对照组。所有患者上肢Brunnstrom评分及Ashworth评分≥Ⅱ级。BTXA组注射BTXA后，进行康复治疗，对照组仅进行康复治疗。在治疗前和治疗后1周、1、2、3月进行Ashworth评分评价痉挛状态，Brunnstrom评价及Fugl-Meyer上肢运动分评价运动功能恢复程度，FIM(Functional Independence Measure)评分评价日常生活活动能力(Activities of daily living，ADL)。结果：BTXA组较对照组其痉挛程度显著降低，Brunnstrom运动恢复等级提高，FIM评分无显著差异，但自我护理评分在2月末较对照组出现统计学差异。治疗过程中没有发现不良反应。结论：BTXA缓解偏瘫后上肢痉挛状态，辅以康复治疗可以促进上肢Brunnstrom运动恢复的等级，提高上肢运动能力和自我护理能力。为脑卒中后痉挛康复提供了新途径。
Objective : To investigate the effect of Botulinum toxin type A(BTXA)and rehabilitation on upper limb Brunnstrom stages and ADL(Activities of daily living) after a stroke. Methods : In a randomized controlled trial, 30 patients were allocated to either an experimental group (n=15) that received BTXA into muscles of the effected arm or to a controlled group (n=15). All patients Brunnstrom stage and MAS stage ≥ grade II . All were treated with rehabilitative methods. The intervention was applied for 3 months .All were evaluated for the severity of spasticity (Modified Ashworth Scale,MAS) ,the level of impairment (Brunnstrom assessment and Fugl-Meyer upper limb test) and disability(Functional Independence Measure, FIM) before treatment and after 1 week, 1, 2, 3 months. Results: Patients who received BTXA had significant reduction of muscle tone(P<0.01). Patients in the experimental group performed better on the Brunnstrom stages and Fugl-Meyer test at the end of 2 months (P<0.05). Results on FIM had no effect a
t the level of disability , but had greater improvement in self-care at the end of 2 months. There were no major adverse events associated with injection of BTXA. Conclusions: Intramuscular injection of BTXA is safe and useful in reducing spasticity of the arm and finger muscles. Combined with rehabilitation ,it can improve the patients' upper limb Brunnstrom stages, motor ability and self-care providing a new way in treating spasticity after a stroke.
Objective : To investigate the effect of Botulinum toxin type A(BTXA)and rehabilitation on upper limb Brunnstrom stages and ADL(Activities of daily living) after a stroke. Methods : In a randomized controlled trial, 30 patients were allocated to either an experimental group (n=15) that received BTXA into muscles of the effected arm or to a controlled group (n=15). All patients Brunnstrom stage and MAS stage ≥ grade II . All were treated with rehabilitative methods. The intervention was applied for 3 months .All were evaluated for the severity of spasticity (Modified Ashworth Scale,MAS) ,the level of impairment (Brunnstrom assessment and Fugl-Meyer upper limb test) and disability(Functional Independence Measure, FIM) before treatment and after 1 week, 1, 2, 3 months. Results: Patients who received BTXA had significant reduction of muscle tone(P<0.01). Patients in the experimental group performed better on the Brunnstrom stages and Fugl-Meyer test at the end of 2 months (P<0.05). Results on FIM had no effect a
t the level of disability , but had greater improvement in self-care at the end of 2 months. There were no major adverse events associated with injection of BTXA. Conclusions: Intramuscular injection of BTXA is safe and useful in reducing spasticity of the arm and finger muscles. Combined with rehabilitation ,it can improve the patients' upper limb Brunnstrom stages, motor ability and self-care providing a new way in treating spasticity after a stroke.
引文
[1]、各类脑血管疾病诊断要点．中华神经科杂志．1996；29(6)：379-380
[2]、 National Institutes of Health Consensus Development Conference. Clinical use of botulinum toxin.Arch Neural. 1991;48:1294～1298
[3]、Anthony B.W. Assessment of muscle tone. Age and Ageing.2000;29:385～386
[4]、纪树荣，刘璇．脑卒中患者上肢和手功能的康复评定．现代康复．2000；4(4)：489～491
[5]、Lagalla G, Danni M,Reiter F, et al.Post-stroke spasticity mangement with repeated botulinum toxin injections in the upper limb. American Journal of Physical Medicine & Rehabilitation.2000;79:377～384
[6]、Brin ME Dosing, Administration, and a Treatment Algorithm for use of Botulinum Toxin A for Adult-Onset Spasticity. Muscle & Nerve. 1997; Supple 6:208
[7]、施玉梁，胡谦．肉毒杆菌神经毒素作用机制的研究进展．生物化学与生物物理进展．1998；25(2)：126～130
[8]、Das TK, Park DM.Effect of treatment with botulinum toxin on spasticity.Postgrad Med J. 1989;65:208～210
[9]、谈跃，任惠主编．脑卒中现代临床与康复．云南科技出版社．1999；49～52
[10]、Marcela P,Marisa C,Alfonsina d S,et al.Functional and clinical changes in upper limb spastic patients treated with botulinum toxin(BTX).Functional Neurology. 2000;15:147
[11]、Hilde M F,Willy J D,Beat E S, et al. Effect of a Therapeutic Intervention for the Hemiplegic Upper Limb in the Acute Phase After Stroke A Single-Blind, Randomized, Controlled Multicenter Trial.Stroke. 1998;29:785～792
[12]、Brashear A,Gordon M F,Elovic E, et al.Intramuscular Injection of Botulinum Toxin for Treatment of Wrist and Finger Spasticity after a Strokc.N Engl J Meal. 2002;347:395～400
[13]、王新，曲镭，戴红．功能独立性评定(FIM)的特性及临床应用．中华物理医学杂志．1997；19(4)：239～241
[14]、A.M.O Bakheit, A.F.Thilmann, A.B.Ward, et al. A Randomized Double-Blind Placebo-Controlled, Dose-Ranging Study to Compare the Efficacy and Safety of Three Doses of Botulinum Toxin Type A (Dysport) With Placebo in Upper Limb Spasticity After Stroke. Stroke. 2000; 31:2402～2406
[15]、Lagalla G,Danni M,Reiter F, et al.Post-stroke spasticity mangement with repeated botulinum toxin injections in the upper limb.American Journal of Physical Medicine & Rehabilitation.2000;79:377～384
[16]、Hesse S,Krajnik J,Lueke D,et al.Ankle muscle activity before and after botulinum toxin therapy for lowers limb extensor spasticity in chronic hemiparetic patients. Stroke. 1996;27(3):455～460
[17]、Pullman SL,Greene P, Fahn S,et al.Approach to the treatment of limb disorders with botulinum toxin A.Experience with 187 patients.Arch Neurol. 1996;53(7):617～624
[2]、 National Institutes of Health Consensus Development Conference. Clinical use of botulinum toxin.Arch Neural. 1991;48:1294～1298
[3]、Anthony B.W. Assessment of muscle tone. Age and Ageing.2000;29:385～386
[4]、纪树荣，刘璇．脑卒中患者上肢和手功能的康复评定．现代康复．2000；4(4)：489～491
[5]、Lagalla G, Danni M,Reiter F, et al.Post-stroke spasticity mangement with repeated botulinum toxin injections in the upper limb. American Journal of Physical Medicine & Rehabilitation.2000;79:377～384
[6]、Brin ME Dosing, Administration, and a Treatment Algorithm for use of Botulinum Toxin A for Adult-Onset Spasticity. Muscle & Nerve. 1997; Supple 6:208
[7]、施玉梁，胡谦．肉毒杆菌神经毒素作用机制的研究进展．生物化学与生物物理进展．1998；25(2)：126～130
[8]、Das TK, Park DM.Effect of treatment with botulinum toxin on spasticity.Postgrad Med J. 1989;65:208～210
[9]、谈跃，任惠主编．脑卒中现代临床与康复．云南科技出版社．1999；49～52
[10]、Marcela P,Marisa C,Alfonsina d S,et al.Functional and clinical changes in upper limb spastic patients treated with botulinum toxin(BTX).Functional Neurology. 2000;15:147
[11]、Hilde M F,Willy J D,Beat E S, et al. Effect of a Therapeutic Intervention for the Hemiplegic Upper Limb in the Acute Phase After Stroke A Single-Blind, Randomized, Controlled Multicenter Trial.Stroke. 1998;29:785～792
[12]、Brashear A,Gordon M F,Elovic E, et al.Intramuscular Injection of Botulinum Toxin for Treatment of Wrist and Finger Spasticity after a Strokc.N Engl J Meal. 2002;347:395～400
[13]、王新，曲镭，戴红．功能独立性评定(FIM)的特性及临床应用．中华物理医学杂志．1997；19(4)：239～241
[14]、A.M.O Bakheit, A.F.Thilmann, A.B.Ward, et al. A Randomized Double-Blind Placebo-Controlled, Dose-Ranging Study to Compare the Efficacy and Safety of Three Doses of Botulinum Toxin Type A (Dysport) With Placebo in Upper Limb Spasticity After Stroke. Stroke. 2000; 31:2402～2406
[15]、Lagalla G,Danni M,Reiter F, et al.Post-stroke spasticity mangement with repeated botulinum toxin injections in the upper limb.American Journal of Physical Medicine & Rehabilitation.2000;79:377～384
[16]、Hesse S,Krajnik J,Lueke D,et al.Ankle muscle activity before and after botulinum toxin therapy for lowers limb extensor spasticity in chronic hemiparetic patients. Stroke. 1996;27(3):455～460
[17]、Pullman SL,Greene P, Fahn S,et al.Approach to the treatment of limb disorders with botulinum toxin A.Experience with 187 patients.Arch Neurol. 1996;53(7):617～624
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