A型肉毒毒素联合重复经颅磁刺激对痉挛型 双瘫患儿下肢运动功能的影响
Effect of Botulinum Toxin Type A Combined with Repetitive Transcranial Magnetic Stimulation on Lower Limb Motor Function in Children with Spastic Diplegia
DOI: 10.12677/acm.2026.1641609, PDF,   
作者: 赵瓅玮：青岛大学青岛医学院，山东 青岛；青岛大学附属妇女儿童医院康复科，山东 青岛；于晓明, 李建飞, 魏 然, 郇 赛：青岛大学附属妇女儿童医院康复科，山东 青岛；李铁山*：青岛大学附属医院康复科，山东 青岛
关键词: A型肉毒毒素；重复经颅磁刺激；痉挛型双瘫；运动功能；Botulinum Toxin Type A； Repetitive Transcranial Magnetic Stimulation； Spastic Diplegia； Motor Function
摘要: 目的：探讨A型肉毒毒素(BoNT-A)联合重复经颅磁刺激(rTMS)对痉挛型双瘫(DCP)患儿肌张力及运动功能的临床疗效，为临床治疗提供循证依据。方法：选取2025年1月至2026年1月收治的拟纳入72例DCP患儿，采用随机数字表法分为观察组(BoNT-A + 常规康复 + rTMS)和对照组(BoNT-A + 常规康复)，每组36例；研究期间脱落2例，后续补充2例，最终纳入74例完成研究。治疗前及治疗后1月、3月，采用改良Ashworth量表(MAS)、表面肌电图(sEMG)均方根值(RMS)、粗大运动功能量表(GMFM-88) D/E区评分及10米步行测试(10 MWT)评估疗效。计量资料经正态性和方差齐性检验后，采用重复测量方差分析进行组内、组间及交互作用差异分析，结合Cohen (1988)偏η2标准判定效应量临床意义。结果：干预1个月时，观察组MAS评分、RMS值、GMFM-D区评分改善均优于对照组(P < 0.05)，干预3个月时观察组MAS评分组间差异无统计学意义(P > 0.05)，但RMS值仍优于对照组(P < 0.05)，且GMFM-E区评分、步行速度改善优势尤为突出(P < 0.05)，效应量结果提示各项改善具备对应临床价值。结论：BoNT-A联合rTMS可更显著改善DCP患儿肌张力及运动功能，疗效具有明确临床意义，安全性良好，值得临床推广应用。
Abstract: Objective: To investigate the clinical efficacy of botulinum toxin type A (BoNT-A) combined with repetitive transcranial magnetic stimulation (rTMS) on muscle tone and motor function in children with diplegic cerebral palsy (DCP), and to provide evidence-based basis for clinical treatment. Methods: A total of 72 children with DCP scheduled for enrollment admitted from January 2025 to January 2026 were randomly divided into the observation group (BoNT-A + routine rehabilitation + rTMS) and the control group (BoNT-A + routine rehabilitation) by random number table method, with 36 cases in each group. During the study period, 2 cases dropped out and 2 cases were subsequently supplemented, and 74 cases were finally included to complete the study. Before treatment, 1 month and 3 months after treatment, the therapeutic efficacy was evaluated by Modified Ashworth Scale (MAS), root mean square (RMS) of surface electromyography (sEMG), scores of zone D and E of Gross Motor Function Measure-88 (GMFM-88) and 10-meter walking test (10 MWT). After normality test and homogeneity test of variance, repeated measures analysis of variance was used to analyze intra-group, inter-group and interaction differences, and the clinical significance of effect size was determined in combination with Cohen’s (1988) partial η2 criterion. Results: At 1 month of intervention, the improvements of MAS score, RMS value and GMFM-D zone score in the observation group were all better than those in the control group (P < 0.05). At 3 months of intervention, there was no statistically significant inter-group difference in MAS score in the observation group (P > 0.05), but the RMS value was still better than that in the control group (P < 0.05), and the advantages of improving GMFM-E zone score and walking speed were particularly prominent (P < 0.05). The effect size results indicated that all improvements had corresponding clinical value. Conclusion: BoNT-A combined with rTMS can significantly improve muscle tone and motor function in children with DCP, with definite clinical efficacy and favorable safety, which is worthy of clinical promotion and application.
文章引用：赵瓅玮, 于晓明, 李建飞, 魏然, 郇赛, 李铁山. A型肉毒毒素联合重复经颅磁刺激对痉挛型 双瘫患儿下肢运动功能的影响[J]. 临床医学进展, 2026, 16(4): 3457-3469. https://doi.org/10.12677/acm.2026.1641609

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