摘要
目的研究A型肉毒毒素注射治疗脑卒中后肩痛的疗效。方法选择脑卒中患者共40例,采用随机数字表法分为两组。实验组采用A型肉毒毒素注射治疗结合运动疗法,对照组单纯采用运动疗法,两组均连续治疗4周。在患者入组前、治疗后1周、治疗后2周、治疗后4周分别对患者肩关节活动度(ROM)、疼痛评分(VAS)进行相关的功能评定,评价两组的治疗效果。结果实验组和对照组治疗1周后、治疗2周后、治疗4周后VAS评分均比治疗前明显降低(t分别=2.57、6.57、4.38;9.16、3.74、6.27,P均<0.05)。实验组治疗前、治疗1周后、治疗2周后的VAS评分与对照组比较,差异无统计学意义(t分别=5.17、7.04、2.20,P均>0.05),但治疗4周后VAS评分明显低于对照组(t=5.29,P<0.05)。实验组治疗前后屈曲、外旋ROM比较,差异有统计学意义(F分别=46.53、19.49,P均<0.05),但治疗前后外展ROM比较,差异无统计学意义(F=3.96,P>0.05)。实验组治疗1周后、治疗2周后、治疗4周后外旋ROM评分均比治疗前明显增加,治疗4周后屈曲ROM评分比治疗前明显增加,差异有统计学意义(t分别=4.84、6.24、5.84,P均<0.05)。实验组与对照组治疗4周后屈曲ROM比较,差异有统计学意义(t分别=5.90,P<0.05);但治疗4周后外展、外旋ROM比较,差异均无统计学意义(t分别=1.36、0.92,P均>0.05)。结论关节腔注射A型肉毒毒素能减轻病程3个月以上卒中患者后肩痛的疼痛程度,改善肩关节活动范围。肩痛减轻后配合康复训练有助于提高运动功能。
Objective To investigate the efficacy of botulinum toxin type A injection in treatment of scapulalgia after stroke.Methods A total of 40 patients with stroke were randomized into two groups.The experimental group was treated with botulinum toxin type A injection combined with exercise therapy,while the control group only received exercise therapy.The course of two group were 4 weeks.Before treatment and one week,two weeks and four weeks after treatment,patients’shoulder mobility and VAS score were evaluated and compared between two groups.Results One week,two weeks and four weeksafter treatment,the VAS scores of the experimental group and the control group were significantly lower than before the treatment(t=2.57,6.57,4.38,9.16,3.74,6.27,P<0.05).Before treatment and one week,two weeks after treatment,the differences in VAS score betweenthe experimental group and control group were not statistically significant(t=5.17,7.04,2.20,P>0.05),while the difference in the VAS score at 4 weeks after treatment was statistically significant(t=5.29,P<0.05).There were statistically significant differences in buckling and extorsion ROM of experimental group before and after the treatment(F=46.53,19.49,P<0.05)except forabduction ROM(F=3.96,P>0.05).The extorsion ROM scores of the experimental group at one week,two weeks and four weeks after treatment were significantly higher than before the treatment(t=4.84,6.24,P<0.05).The buckling ROM score of the experimental group at four weeks after treatment was significantly higher than before the treatment(t=5.84,P<0.05).Four weeks after treatment,the buckling ROM score between two groups was significantly different(t=5.90,P<0.05).However,there was no statistically significant difference in extorsion and abduction ROM scores between two groups(t=1.36,0.92,P>0.05).Conclusion Injection of botulinum toxin type Acan reduce the pain degree of patients with scapulalgia after stroke whose course of disease larger than 3 months and improve the range of shoulder joint activity.After relieving scapulalgia,rehabilitation training helps to improve motion function.
作者
吴登宠
陈炳
张垣
周瑜欢
WU Dengchong;CHEN Bing;ZHANG Yuan(Department of Rehabilitation,Wenzhou Hospital of Traditional Chinese Medicine,Wenzhou 325000,China)
出处
《全科医学临床与教育》
2018年第4期406-410,共5页
Clinical Education of General Practice
关键词
卒中后肩痛
A型肉毒毒素
运动疗法
关节活动度
scapulalgia after stroke
botulinum toxin type A
exercise therapy
range of motion
