肉毒毒素注射治疗慢性脑卒中成人腕部和手指痉挛过度活动：三种注射技术的随机对照试验

Botulinum toxin injection into the forearm muscles for wrist and fingers spastic overactivity in adults with chronic stroke: a randomized controlled trial comparing three injection techniques.

机构信息

1Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.

出版信息

Clin Rehabil. 2014 Mar;28(3):232-42. doi: 10.1177/0269215513497735. Epub 2013 Aug 14.

DOI:10.1177/0269215513497735

PMID:23945164

Abstract

OBJECTIVE

To compare the outcome of manual needle placement, electrical stimulation and ultrasonography-guided techniques for botulinum toxin injection into the forearm muscles of adults with arm spasticity.

DESIGN

Randomized controlled trial.

SETTING

University hospital.

SUBJECTS

Sixty chronic stroke patients with wrist and fingers spasticity.

INTERVENTION

After randomization into three groups, each patient received botulinum toxin type A in at least two of these muscles: flexor carpi radialis and ulnaris, flexor digitorum superficialis and profundus (no fascicles selection). The manual needle placement group underwent injections using palpation; the electrical stimulation group received injections with electrical stimulation guidance; the ultrasonography group was injected under sonographic guidance. A sole injector was used.

MAIN MEASURES

All patients were evaluated at baseline and four weeks after injection.

OUTCOMES

Modified Ashworth Scale; Tardieu Scale; wrist and fingers passive range of motion.

RESULTS

One month after injection, Modified Ashworth Scale scores improved more in the electrical stimulation group than the manual needle placement group (wrist: P = 0.014; fingers: P = 0.011), as well as the Tardieu angle (wrist: P = 0.008; fingers: P = 0.015) and passive range of motion (wrist: P = 0.004). Furthermore, Modified Ashworth Scale scores improved more in the ultrasonography group than in the manual needle placement group (wrist: P = 0.001; fingers: P = 0.003), as well as the Tardieu angle (wrist: P = 0.010; fingers: P = 0.001) and passive range of motion (wrist: P < 0.001; proximal interphalangeal joints: P = 0.009). No difference was found between the ultrasonography and electrical stimulation groups.

CONCLUSIONS

Instrumental guidance may improve the outcome of botulinum toxin injections into the spastic forearm muscles of stroke patients.

摘要

目的

比较手动针置位、电刺激和超声引导技术用于成人前臂肌肉中肉毒毒素注射治疗手臂痉挛的效果。

设计

随机对照试验。

地点

大学医院。

受试者

60 例慢性脑卒中患者，腕部和手指痉挛。

干预措施

将患者随机分为三组，每组患者均在至少两块肌肉中接受 A 型肉毒毒素注射治疗：桡侧腕屈肌和尺侧腕屈肌、指浅屈肌和指深屈肌（不选择肌束）。手动针置位组通过触诊进行注射；电刺激组接受电刺激引导下的注射；超声组在超声引导下注射。使用单针注射器。

主要观察指标

所有患者在基线和注射后 4 周进行评估。

结果

注射后 1 个月，电刺激组的改良 Ashworth 量表评分改善程度优于手动针置位组（腕部：P = 0.014；手部：P = 0.011），Tardieu 角（腕部：P = 0.008；手部：P = 0.015）和被动活动度（腕部：P = 0.004）也有改善。此外，超声组的改良 Ashworth 量表评分改善程度优于手动针置位组（腕部：P = 0.001；手部：P = 0.003），Tardieu 角（腕部：P = 0.010；手部：P = 0.001）和被动活动度（腕部：P < 0.001；近侧指间关节：P = 0.009）也有改善。超声组与电刺激组之间没有差异。