同时向多块肌肉注射肉毒杆菌毒素对呈现膝关节僵硬步态的中风患者的功能障碍、活动能力、参与度及生活质量的影响。

Effect of simultaneous botulinum toxin injections into several muscles on impairment, activity, participation, and quality of life among stroke patients presenting with a stiff knee gait.

作者信息

Caty Gilles D, Detrembleur Christine, Bleyenheuft Corinne, Deltombe Thierry, Lejeune Thierry M

机构信息

Physical Medicine and Rehabilitation Department, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.

出版信息

Stroke. 2008 Oct;39(10):2803-8. doi: 10.1161/STROKEAHA.108.516153. Epub 2008 Jul 17.

DOI:10.1161/STROKEAHA.108.516153

PMID:18635841

Abstract

BACKGROUND AND PURPOSE

Walking is an essential activity for daily life and social participation, and it is frequently limited after stroke. A lack of knee flexion during the swing phase (stiff knee) is one of the impairments that restrict walking ability among patients with hemiparetic spasticity. Our purpose was to study the effect of Botulinum toxin type A (BoNT A) injections in several spastic muscles on the impairment, activity, participation, and quality of life of patients with chronic stroke presenting with a stiff knee gait.

METHODS

Twenty chronic hemiparetic poststroke patients with stiff knee gait and ability to walk on a treadmill were recruited. BoNT A was injected into several spastic muscles: the rectus femoris (200 U), semitendinosus (100 U) and triceps surae (200 U). Patients' neurological impairments (Ashworth scale, Duncan-Ely test, Stroke Impairment Assessment Set, and instrumented gait analysis), activity (ABILOCO and 10-m walking test), and participation (SATISPART-Stroke and 36-item Short-Form Health Survey) were assessed before and 2 months after the injection.

RESULTS

BoNT A injection reduced the impairments. It improved Stroke Impairment Assessment Set (56.5 [48-63] to 56.5 [52.5 to 63]; P<0.001), reduced rectus femoris muscle tone (2 [1 to 2.5] to 0 [0 to 1]; P<0.001), and reduced semitendinosus muscle tone (1 [1 to 1.5] to 1 [0 to 1]; P<0.001). Gait analysis demonstrated increased knee flexion during the swing phase (22+/-19 degrees to 27+/-16 degrees ; P=0.03), decreased external mechanical work (0.66+/-0.38 to 0.59+/-0.25 J kg(-1) m(-1); P=0.04), and demonstrated a lower energy cost (5.8+/-1.9 to 4.9+/-1.9 J kg(-1) m(-1); P=0.03). The patients' locomotion ability was improved (2.2+/-1.9 to 3.2+/-2.1 logits; P=0.03). The participation and quality of life remained unchanged.

CONCLUSIONS

BoNT A injections in several muscles improved the stiff knee gait and the locomotion ability in adult stroke patients.

摘要

背景与目的

步行是日常生活和社会参与的一项基本活动，中风后常受到限制。摆动期膝关节屈曲不足（膝关节僵硬）是偏瘫痉挛患者步行能力受限的损伤之一。我们的目的是研究A型肉毒杆菌毒素（BoNT A）注射到几块痉挛肌肉中对慢性中风且有膝关节僵硬步态患者的损伤、活动、参与和生活质量的影响。

方法

招募了20名患有膝关节僵硬步态且能够在跑步机上行走的慢性中风偏瘫患者。将BoNT A注射到几块痉挛肌肉中：股直肌（200单位）、半腱肌（100单位）和小腿三头肌（200单位）。在注射前和注射后2个月评估患者的神经损伤（Ashworth量表、Duncan-Ely试验、中风损伤评估量表和仪器化步态分析）、活动（ABILOCO和10米步行试验）以及参与（SATISPART-中风和36项简短健康调查）。

结果

BoNT A注射减轻了损伤。它改善了中风损伤评估量表（从56.5[48 - 63]到56.5[52.5至63]；P<0.001），降低了股直肌张力（从2[1至2.5]到0[0至1]；P<0.001），并降低了半腱肌张力（从1[1至1.5]到1[0至1]；P<0.001）。步态分析显示摆动期膝关节屈曲增加（从22±19度到27±16度；P = 0.03），外部机械功减少（从0.66±0.38到0.59±0.25 J kg⁻¹ m⁻¹；P = 0.04），并且能量消耗降低（从5.8±1.9到4.9±1.9 J kg⁻¹ m⁻¹；P = 0.03）。患者的运动能力得到改善（从2.2±1.9到3.2±2.1对数单位；P = 0.03）。参与和生活质量保持不变。