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目的初步探讨在肌电引导下采用A型肉毒毒素局部肌肉注射治疗肢体肌张力障碍及痉挛的疗效及安全性。方法共选取32例肢体肌张力障碍或痉挛患者,在肌电引导下采用A型肉毒毒素进行局部相应肌肉注射。痉挛程度评定选用Ashworth分级法,疼痛评定采用数字评分法(NRS),对治疗前后肌张力障碍、肢体痉挛强直以及疼痛情况进行评定。结果32例患者均至少完成1个疗程治疗,每个疗程接受1～2次肉毒毒素注射,患者总有效率为84%,并且患者下肢疗效明显优于上肢,其中下肢和上肢肌张力障碍、肢体痉挛强直的治疗有效率分别为100%与61.5%,疼痛缓解率分别为100%与84.6%。A型肉毒毒素平均起效时间为2周,疗效平均持续时间为13.75周。肉毒毒素副作用主要表现为注射局部肌无力,其次为注射局部疼痛和瘀斑,但均可自行恢复。结论在肌电引导下采用A型肉毒毒素治疗肌张力障碍及痉挛强直肢体疗效显著,副作用轻微且均可自行恢复。
Objective To investigate the efficacy and safety of local intramuscular injection of botulinum toxin type A in the treatment of limb dystonia and spasticity under the guidance of electromyography. Methods A total of 32 patients with limb dystonia or spasticity were selected, and the corresponding intramuscular injection of botulinum toxin type A was performed under the guidance of electromyography. The severity of spasticity was assessed using the Ashworth scale, and the pain score was assessed using the numerical score method (NRS) for dizziness, limb stiffness and pain before and after treatment. Results 32 patients completed at least one course of treatment, each course received 1 or 2 times botulinum toxin injections, the total effective rate was 84%, and the efficacy of lower extremity patients was significantly better than the upper limbs, including lower extremity and upper limb dystonia, Limb spasms ankylosis treatment effective rates were 100% and 61.5%, pain relief rates were 100% and 84.6%. Botulinum toxin type A average onset time of 2 weeks, the average duration of effect was 13.75 weeks. Botulinum toxin side effects mainly manifested as local muscle weakness injection, followed by injection of local pain and ecchymosis, but can be self-healing. Conclusions The use of botulinum toxin type A in the treatment of dystonia and spastic tetanic limbs under the guidance of electromyography has significant curative effect with mild side effects and self-recovery.