Papadonikolakis Anastasios S, Vekris Marios D, Korompilias Anastasios V, Kostas John P, Ristanis Stavros E, Soucacos Panayotis N
Department of Orthopaedic Surgery, University of Athens, School of Medicine, GR-145 61 Athens, Greece.
Acta Orthop Scand. 2003 Dec;74(6):749-55. doi: 10.1080/00016470310018315.
Injection of botulinum type A toxin is a new treatment for spasticity.
We evaluated the effect of botulinum A toxin (BTX-A) in the lower limb muscles of patients having cerebral palsy. We tested 49 patients before and, on average, 4 (2-9) months after giving the toxin. The evaluation included 3-dimensional computerized gait analysis, changes in mobility level, using the Gillette Functional Assessment Questionnaire, and gastrocnemius muscle bulk, using ultrasonographic measurements.
The patients were divided into 3 groups, according to the site of BTX-A administration (hamstrings, gastrocnemius and multilevel). Those who were injected in the hamstrings showed a significant improvement in only the maximum knee extension angle during the gait cycle. Those with spastic equinus who were injected in the gastrocnemius muscle responded better than the other groups. The ankle angle on the initial contact, terminal stance and pre-swing, maximum dorsiflexion, ankle range of motion, per cent of single support and gait velocity improved significantly. Overall, the patients showed significant improvements in motor skill performance and functional health.
Our findings indicate that botulinum type A toxin can be given as an adjuvant to conservative treatment of patients with cerebral palsy.
注射A型肉毒杆菌毒素是治疗痉挛的一种新方法。
我们评估了A型肉毒杆菌毒素（BTX-A）对脑瘫患者下肢肌肉的作用。我们在49例患者注射毒素前以及平均注射后4（2 - 9）个月进行了测试。评估包括三维计算机步态分析、使用吉列功能评估问卷评估活动水平变化以及使用超声测量腓肠肌体积。
根据BTX-A的注射部位（腘绳肌、腓肠肌和多部位）将患者分为3组。注射到腘绳肌的患者仅在步态周期中的最大膝关节伸展角度有显著改善。注射到腓肠肌的痉挛性马蹄足患者比其他组反应更好。初始接触、终末站立和摆动前期的踝关节角度、最大背屈、踝关节活动范围、单支撑百分比和步态速度均有显著改善。总体而言，患者在运动技能表现和功能健康方面有显著改善。
我们的研究结果表明，A型肉毒杆菌毒素可作为脑瘫患者保守治疗的辅助手段。
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