Gait and Motor Control Analysis Laboratories, MossRehab, Elkins Park, Pennsylvania 19027, USA.
Am J Phys Med Rehabil. 2012 Sep;91(9):729-46. doi: 10.1097/PHM.0b013e31824fa9ca.
This study aimed to provide clinical injection data and real-world patient-reported and clinical outcomes for the chemodenervation and neurolytic treatment of muscle overactivity including spasticity in patients with traumatic brain injury and stroke.
This study used a prospective multicenter observational design. The participants were 487 patients with stroke or traumatic brain injury. The interventions used were onabotulinumtoxin A or phenol. Nine subjects received both onabotulinumtoxin A and phenol. The main outcome measures were satisfaction and goal attainment, pain, and Ashworth Scale scores.
The most commonly treated pattern of dysfunction in the upper limb was the flexed wrist, with the flexor carpi radialis as the most frequently treated muscle. The mean total dose for the upper limb muscle was 57.7 ± 34.1 U, and phenol volume was 3.9 ± 0.7 ml. The most commonly treated pattern of dysfunction in the lower limb was the equinovarus/equinus foot, with the medial/lateral gastrocnemius as the most frequently treated muscles. The mean total dose for the lower limb muscle was 93.8 ± 63.5 U, and phenol volume was 4.1 ± 1.3 ml. There was a significant improvement in Ashworth Scale and pain scores. Generally, the patients reported that they were satisfied with their treatment and made progress toward their goals. No significant treatment-related adverse effects were reported.
Based on 487 patients with stroke and traumatic brain injury who were selected by their physician and clinical presentation for treatment using chemodenervation and neurolysis, this report of injection data reflecting actual clinical practice may serve as a further clinical guide in the management of patients with muscle overactivity, including spasticity.
本研究旨在为化学神经切断术和神经溶解术治疗创伤性脑损伤和中风患者肌肉过度活动（包括痉挛）提供临床注射数据和真实患者报告的临床结局。
本研究采用前瞻性多中心观察性设计。参与者为 487 名中风或创伤性脑损伤患者。干预措施为肉毒毒素 A 或苯酚。9 名受试者同时接受肉毒毒素 A 和苯酚治疗。主要结局指标为满意度和目标达成、疼痛和 Ashworth 量表评分。
上肢最常见的功能障碍模式是屈腕，最常治疗的肌肉是桡侧腕屈肌。上肢肌肉的平均总剂量为 57.7 ± 34.1 U，苯酚体积为 3.9 ± 0.7 ml。下肢最常见的功能障碍模式是马蹄内翻/马蹄足，最常治疗的肌肉是腓肠肌内侧/外侧。下肢肌肉的平均总剂量为 93.8 ± 63.5 U，苯酚体积为 4.1 ± 1.3 ml。Ashworth 量表和疼痛评分均有显著改善。一般来说，患者报告对治疗满意，并朝着目标取得进展。未报告与治疗相关的严重不良事件。
根据 487 名中风和创伤性脑损伤患者，他们的医生根据他们的临床表现选择接受化学神经切断术和神经溶解术治疗，本报告反映实际临床实践的注射数据可能进一步为肌肉过度活动（包括痉挛）患者的管理提供临床指导。
