Pradon Didier, Hutin Emilie, Khadir Simon, Taiar Redha, Genet François, Roche Nicolas
Laboratoire d'Analyse du Mouvement, Raymond Poincaré, Garches, France.
Clin Biomech (Bristol). 2011 Oct;26(8):867-72. doi: 10.1016/j.clinbiomech.2011.04.003. Epub 2011 May 17.
Botulinum toxin is commonly used to treat spastic equinus foot. This treatment seems to improve gait in hemiplegic patients when used alone or combined with an ankle-foot orthosis. However, the nature and effects of this improvement have until now rarely been studied. The aim of this study was to quantify the impact of a Botulinum toxin injection in the triceps surae of hemiplegic patients with equinus foot, used either alone or in combination with an ankle-foot orthosis, on the kinematics and dynamics of the paretic lower limb, and to determine the advantage of combining an ankle-foot orthosis with this pharmacological treatment.
Patients were assessed using gait analysis to measure spatio-temporal, kinematic and dynamic parameters of the gait cycle before Botulinum toxin injection and then 3 and 6weeks after injection. Eight chronic hemiplegics following central nervous system lesion were included.
Botulinum toxin injection led to an increase in velocity, peak ankle dorsiflexion during stance phase, and peak knee flexion during swing phase. It also resulted in an increased peak plantarflexion moment. Use of ankle-foot orthosis led to a specific increase in peak ankle dorsiflexion during swing phase and also increased peak plantarflexion moment.
The results indicate that combined Botulinum toxin injection of the triceps surae and wearing an ankle-foot orthosis is more effective than the use of Botulinum toxin only. Use of an ankle-foot orthosis increases ankle dorsiflexion during the swing phase and does not reduce the benefits gained by the use of Botulinum toxin in stance phase.
肉毒杆菌毒素常用于治疗痉挛性马蹄足。单独使用或与踝足矫形器联合使用时，这种治疗似乎能改善偏瘫患者的步态。然而，这种改善的性质和效果至今鲜有研究。本研究的目的是量化肉毒杆菌毒素注射到患有马蹄足的偏瘫患者小腿三头肌中（单独使用或与踝足矫形器联合使用）对患侧下肢运动学和动力学的影响，并确定将踝足矫形器与这种药物治疗相结合的优势。
在注射肉毒杆菌毒素前以及注射后3周和6周，使用步态分析对患者进行评估，以测量步态周期的时空、运动学和动力学参数。纳入了8名中枢神经系统损伤后的慢性偏瘫患者。
肉毒杆菌毒素注射导致速度增加、站立期踝关节背屈峰值增加以及摆动期膝关节屈曲峰值增加。它还导致跖屈峰值力矩增加。使用踝足矫形器导致摆动期踝关节背屈峰值特异性增加，并且也增加了跖屈峰值力矩。
结果表明，小腿三头肌联合注射肉毒杆菌毒素并佩戴踝足矫形器比仅使用肉毒杆菌毒素更有效。使用踝足矫形器在摆动期增加了踝关节背屈，并且不会降低在站立期使用肉毒杆菌毒素所获得的益处。
