A型肉毒毒素在超声定位下注射治疗儿童脑性瘫痪的临床应用

肉毒毒素(Botulinum toxin，BTX)是由肉毒梭菌产生的一种神经毒素，通过抑制神经递质释放，具有较强的肌肉松弛作用。7型BTX中，A型肉毒毒素(Botulinum toxin A，BTX-A)毒力最强且最稳定，最早被用于实验研究及临床治疗。

A型肉毒毒素注射治疗儿童脑性瘫痪主要是通过局部肌肉注射来降低痉挛肌群的肌张力，改善相应部位关节的活动度，同时结合与治疗目的相关的功能训练，可使大脑功能重组，肌肉运动模式激活并趋向正常，肌群间的协调控制能力得以提高，使运动达到或接近正常的生物力学对线，从而提高站立、步行能力或改善步态，提高坐位能力或改善坐姿，提高上肢运动能力，同时也可缓解疼痛，提高配戴矫形器的耐受性。未收录医院康复科王志娇

A型肉毒毒素注射治疗适用于所有痉挛型脑性瘫痪儿童，尤其适用于痉挛程度为中重度且已经运动功能训练改善不明显的患儿。股内收肌注射以纠正髋内收步态；髂腰肌注射以提高站立与步行能力；在膝关节屈曲大于20°或有蹲伏步态时进行?绳肌注射；腓肠肌注射可以减轻尖足倾向，改善步行姿势；重度患儿同时给予股内收肌和?绳肌注射可以提高坐位能力。纠正拇指内收、握拳及前臂旋前畸形可以改善患儿上肢精细运动能力。

目前国内外常用的BTX-A是美国保妥适，较稀释的溶液适用于下肢肌肉；较浓缩的溶液适用于上肢肌肉。BTX-A局部肌肉注射减轻痉挛的起效时间为12～72小时，临床效果至少持续3～6个月。国外有报道：BTX-A用于脑性瘫痪儿童的全身最大剂量可以达20～25U／kg，总量不超过600U，较大剂量的BTX-A注射治疗可以更有效的缓解肌肉痉挛状态，更好的结合功能训练，改善运动功能，提高生活质量，并且不会提高不良反应的发生率。BTX-A注射治疗儿童脑性瘫痪具有良好的安全性，极少产生严重的不良反应。局部不良反应是BTX-A在靶肌肉或临近肌肉过度活化的结果；全身不良反应是毒素在远部肌肉或器官的作用。

彩色多普勒超声定位下进行A型肉毒毒素注射治疗可以更加准确的找到痉挛的靶肌肉，可以避开血管、神经，减少出血，减轻患儿痛苦,同时减少BTX-A向临近肌肉扩散，降低不良反应发生率。

在脑性瘫痪儿童的康复治疗中，A型肉毒毒素注射治疗作为一种辅助疗法，适用于2岁以上姿势明显异常、严重影响正常生活的痉挛型脑性瘫痪儿童，它为康复训练创造肌肉松弛的有利条件，以便通过功能训练纠正异常姿势、改善运动功能，提高生活质量，同时可以缩短患儿康复治疗时间，降低家长心理压力，减轻社会负担。

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