目的：评估A型肉毒毒素（type A botulinum toxin，BTX-A）注射结合系列石膏固定对痉挛型脑性瘫痪（cerebral palsy，CP）儿童精细运动功能及上肢痉挛程度的影响。

方法：将119例CP患儿按临床分型及手动能力分类系统（Manual Ability Classification System，MACS）分级进行分层后，采用随机数字表法分为试验组（61例）及对照组（58例）。对照组接受单次BTX-A注射与上肢常规康复训练及康复指导，试验组加用系列石膏固定。使用精细运动能力测试量表（Fine Motor Function Measure，FMFM）和改良Tardieu量表（Modified Tardieu Scale，MTS）（以参数X评估痉挛程度）于BTX-A注射前、注射后1个月以及注射后3个月评估治疗效果。

结果：治疗后1个月，2组患儿FMFM评分和MTS量表参数X评分均显著改善（P＜0.05），且试验组优于对照组（P＜0.05）。治疗3个月后试验组各项评分维持改善但略有降低，对照组除肘关节伸展外其他指标均与治疗后1个月无统计学差异。

结论：BTX-A结合上肢常规康复训练能显著改善CP儿童的上肢肌肉痉挛和大关节运动功能，增加系列石膏固定有助于进一步提升手功能并延长疗效。

Objective： To evaluate the effects of botulinum toxin type A (BTX-A) injection combined with serial plaster casting on fine motor function and upper limb spasticity in children with spastic cerebral palsy (CP).

Methods： A total of 119 children with CP were stratified according to clinical subtype and Manual Ability Classification System (MACS) level, and then randomly divided into an experimental group (n=61) and a control group (n=58) using a random number table. The control group received a single BTX-A injection combined with conventional upper limb rehabilitation training and guidance. The experimental group received additional serial plaster casting. Therapeutic effects were assessed using the Fine Motor Function Measure (FMFM) and the Modified Tardieu Scale (MTS), which assessed spasticity using parameter X, before BTX-A injection, at 1 month, and at 3 months after injection.

Results： At 1 month after treatment, FMFM scores and MTS parameter X scores significantly improved in both groups (P < 0.05), with the experimental group showing superior outcomes compared to the control group (P < 0.05). At 3 months, all scores in the experimental group remained improved despite a slight decrease, while in the control group, all indicators except for elbow extension showed no statistically significant difference compared to those at 1 month post-treatment.

Conclusion： BTX-A combined with conventional upper limb rehabilitation training can significantly improve upper limb muscle spasticity and large-joint motor function in children with CP. The addition of serial plaster casting helps to further enhance hand function and prolong the therapeutic effect.