| Objectives:Through the observation of the spastic cerebral palsy children who were treated by ultrasound guided botulinum toxin A(BTX-A) injection combining with conventional rehabilitation training, understanding the BTX- A efficacy to relieve muscle tension and improve the motor function, the treatment aging.Subjects and Methods: Selected 42 cases of spastic cerebral palsy children who were diagnosed and treated in the department of rehabilitation medicine of Anhui Provincial Children’s hospital inpatient and outpatient from September 2014 to August 2015, randomly divided them into treatment group(n = 21: 15 males; 6 female cases) and control group(21 cases: males and 16; 5 cases were female), the general information of all patients were statistical file. The children in the treatment group were received ultrasound guided BTX-A injection after the completion of the blood routine, liver and kidney function and blood coagulation detection check in the hospital, and started routine rehabilitation training(exercise therapy and physical therapy) the next day after injection. The control group were underwent routine rehabilitation training. Using the modified Ashworth scale(MAS) and gross motor function measure table(GMFM) to evaluate the spasm degree of lower limb muscle and gross motor function of each patient respectively before treatment, 1 month, 3 months and 6 months after treatment. MAS was divided into level 0,Ⅰ,Ⅰ+,Ⅱ,Ⅲ and Ⅳ from low to high, the mainly evaluating method of the muscle tension is the clinical observation records and operation experience of the evaluator and multiple testing; GMFM-88 table was applied to evaluate the degree of the patients’ activities and functions, which was divided intofive functional areas, included supine, sitting, crawling and kneel, stand up and walk, run, jump. The scores of each item were input statistical software(GMAE) which can automatically dispose and analyze the score ratio of each functional area and the total score ratio.Results:(1)Compared with before treatment, the MAS score difference of the control group and treatment group 1 month, 3 months and 6 months after treatment were all statistically significant( P<0.05);(2)Compared with before treatment, the GMFM score difference of the control group and treatment group 1 month, 3 months and 6 months after treatment were all statistically significant( P<0.05);(3)The difference of MAS score and GMFM score in the control group and treatment group at each time point were statistically significant( P<0.05);(4)the MAS score of the treatment group 3 months and 6 months after treatment had no significant difference(P>0.05);Conclusions:(1) The children’s muscle tension of two groups were all alleviated in different degrees, but BTX-A is more able to reduce the muscle tone in the short term. The pain that due to high muscle tension and other pain were relieved in the rehabilitation training process, and the rehabilitation training effect was improved.(2) The children’s motor function of two groups were increased in different degrees, but BTX-A also created the conditions for further rehabilitation training and treatmentbecause of reducing muscular tension, so the children’s motor function was improved more significant;(3) The improvement of the muscle spasm degree and the gross motor function of the children who received rehabilitation training after the BTX-A injection was more obvious than the children who received routine rehabilitation training. BTX-A can relieve muscle spasm, enhance motor function and improve gait more effectively;(4) BTX-A can relieve the spasm time up to 3-6 months;(5) GMFM and MAS table were comprehensively applied to assess the efficacy of the spastic cerebral palsy who were treated with BTX-A, which can more comprehensively response the change trend of the muscle tone and motor function, and then improve the reliability of evaluation. |
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