Tanikawa Hiroki, Kagaya Hitoshi, Inagaki Keisuke, Kotsuji Yusuke, Suzuki Keita, Fujimura Kenta, Mukaino Masahiko, Hirano Satoshi, Saitoh Eiichi, Kanada Yoshikiyo
Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan.
Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan.
Gait Posture. 2018 May;62:409-414. doi: 10.1016/j.gaitpost.2018.04.006. Epub 2018 Apr 6.
The effect of botulinum toxin A (BoNTA) injection on flexed-elbow deformity is usually evaluated using the Modified Ashworth Scale (MAS), but only with the muscle tone at rest. Some patients show the flexed-elbow deformity during gait despite low muscle tone at rest.
This study aimed to evaluate the effect of BoNTA injection on flexed-elbow deformity during gait using a three-dimensional motion analysis system.
Twenty stroke patients with spastic flexed-elbow deformity during gait received BoNTA injections into the upper limb muscles. The MAS score of the elbow flexors, passive elbow range of motion, comfortable overground gait velocity, and elbow flexion angle during treadmill gait were evaluated just before and 2, 6, and 12 weeks after the injection. Twenty-five healthy subjects were also recruited to provide a normal reference of the elbow flexion angle.
The MAS scores at 2, 6 and 12 weeks after the injection were significantly lower than that before the injection. Some patients showed no spasticity at rest but an obviously flexed elbow during gait. The elbow flexion angles during gait at 2 and 6 weeks after the injection were significantly lower than that before the injection.
BoNTA injections to the upper limb muscles reduced muscle tone at rest and flexed-elbow deformity during gait. However, the elbow flexion angle during gait returned to its pre-injection level sooner than the muscle tone at rest. We strongly recommend evaluating muscle tone during motion and at rest, preferably using three-dimensional motion analysis since it can objectively detect small changes.
通常使用改良Ashworth量表（MAS）评估A型肉毒毒素（BoNTA）注射对屈肘畸形的影响，但仅评估静息时的肌张力。一些患者尽管静息时肌张力较低，但在步态中仍表现出屈肘畸形。
本研究旨在使用三维运动分析系统评估BoNTA注射对步态中屈肘畸形的影响。
20例在步态中出现痉挛性屈肘畸形的中风患者接受了上肢肌肉的BoNTA注射。在注射前以及注射后2周、6周和12周，评估肘屈肌的MAS评分、被动肘关节活动范围、舒适的地面行走速度以及跑步机步态期间的肘关节屈曲角度。还招募了25名健康受试者作为肘关节屈曲角度的正常对照。
注射后2周、6周和12周的MAS评分显著低于注射前。一些患者静息时无痉挛，但在步态中出现明显的屈肘。注射后2周和6周步态期间的肘关节屈曲角度显著低于注射前。
上肢肌肉注射BoNTA可降低静息时的肌张力以及步态中的屈肘畸形。然而，步态期间的肘关节屈曲角度比静息时的肌张力更早恢复到注射前水平。我们强烈建议在运动和静息时评估肌张力，最好使用三维运动分析，因为它可以客观地检测到微小变化。
