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目的观察肌电图导引下应用A型肉毒毒素治疗脑卒中偏瘫患者肢体痉挛的临床疗效。方法 65例脑卒中痉挛性偏瘫患者按FMA量表评定分为 3组 ,应用肌电图纪录痉挛肢体在功能位时的运动单元电位数 ,确定治疗肌肉 ,每一部位注射 5U ,0 .2ml国产A型肉毒毒素 ,治疗 3天后由康复训练师亲自或指导家属进行肢体功能训练。采用改良Ashworth分度评分评定痉挛状态 ,FMA量表评定日常生活能力 (上下肢分别统计 )。结果治疗后 ,中、轻度运动障碍者恢复至基本正常 ;严重运动障碍者恢复至明显运动障碍 ;严重运动障碍合并挛缩者可改善其生存质量 ;所有患者增高的肌张力均有明显改善。结论在肌电图导引下 ,A型肉毒毒素作为缓解痉挛药物使用安全、有效 ,对肢体功能的恢复有显著的辅助作用。
Objective To observe the clinical efficacy of botulinum neurotoxin A in the treatment of limb spasticity in hemiparetic stroke patients guided by electromyography. Methods Sixty-five stroke patients with spastic hemiplegia were divided into three groups according to the FMA scale. The electromyogram was used to record the motor unit potentials of the spastic limbs in the functional position. The muscle mass was determined and each site was injected with 5U and 0.2 ml Botulinum toxin type A, after 3 days of treatment by the rehabilitation trainer personally or instructed the families of limb function training. The modified Ashworth scale was used to assess the spasticity, and the FMA scale was used to assess the daily living ability (upper and lower limbs were counted separately). Results After treatment, moderate and mild dyskinesia returned to normal; severe dyskinesia returned to obvious dyskinesia; severe dyskinesia with contracture can improve their quality of life; all patients with increased muscle tone were significantly improved. Conclusions Under the guidance of EMG, botulinum toxin type A is safe and effective as a medication for relieving spasticity and has a significant auxiliary effect on the recovery of limb function.