Hefter Harald, Nickels Werner, Samadzadeh Sara, Rosenthal Dietmar
Department of Neurology, University of Düsseldorf, Düsseldorf, Germany.
Department of Neurology, SRH Health Center, Bad Wimpfen, Germany.
J Int Med Res. 2021 Mar;49(3):300060521998208. doi: 10.1177/0300060521998208.
Outcome differences between selective abobotulinumtoxin type A (aboBoNT/A) injections into the soleus (SOL) and gastrocnemius (GAS) muscles were investigated in post-stroke patients with spastic foot drop.
A monocentric observational study was conducted at a university hospital botulinum toxin clinic including 24 free-walking adult, botulinum toxin-naive patients with post-stroke hemiplegia. AboBoNT/A (800 MU in 4 mL saline) was injected into the SOL or GAS muscle under electromyographic guidance. After 30 days post-injection, the effect of aboBoNT/A injection was assessed by patients. The treating physician scored spasticity and measured angles at the knee and ankle joint and gait speed.
After 30 days, significant improvements of subjective and objective outcome measures were observed. No significant difference was observed in the modified Ashworth scale, gait speed, ankle and knee angles, or their angle combinations between the SOL and GAS groups. Tendencies toward greater active range of motion (RoM) improvement in the SOL group and passive RoM improvement in the GAS group were observed. The difference between active and passive ankle extensions plus knee flexions was significantly larger in the SOL group.
Selective 800 MU aboBoNT/A injections into the SOL or GAS muscle were effective but without relevant clinical difference.
在中风后足下垂患者中，研究选择性注射A型阿泊肉毒素（aboBoNT/A）至比目鱼肌（SOL）和腓肠肌（GAS）的疗效差异。
在一所大学医院的肉毒素诊所进行了一项单中心观察性研究，纳入24例能够自由行走、未接受过肉毒素治疗的中风后偏瘫成年患者。在肌电图引导下，将aboBoNT/A（800 MU溶于4 mL生理盐水中）注射到SOL或GAS肌肉中。注射后30天，由患者评估aboBoNT/A注射的效果。主治医生对痉挛程度进行评分，并测量膝关节和踝关节角度以及步态速度。
30天后，主观和客观疗效指标均有显著改善。SOL组和GAS组在改良Ashworth量表、步态速度、踝关节和膝关节角度或其角度组合方面均未观察到显著差异。观察到SOL组主动活动范围（RoM）改善更大、GAS组被动RoM改善更大的趋势。SOL组主动和被动踝关节伸展加膝关节屈曲之间的差异明显更大。
选择性向SOL或GAS肌肉注射800 MU aboBoNT/A有效，但无相关临床差异。
