定量步态评估和A型肉毒杆菌毒素对脑瘫患儿肌肉骨骼手术的影响。

The effects of quantitative gait assessment and botulinum toxin a on musculoskeletal surgery in children with cerebral palsy.

作者信息

Molenaers Guy, Desloovere Kaat, Fabry Guy, De Cock Paul

机构信息

Department of Pediatric Orthopaedics, University Hospital Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.

出版信息

J Bone Joint Surg Am. 2006 Jan;88(1):161-70. doi: 10.2106/JBJS.C.01497.

DOI:10.2106/JBJS.C.01497

PMID:16391261

Abstract

BACKGROUND

The limits of nonoperative treatment for children with cerebral palsy, including physical therapy and orthotics, commonly lead to orthopaedic surgical intervention. The purpose of the present study was to evaluate the influence of gait analysis and botulinum toxin type-A injections on the timing, prevalence, and frequency of orthopaedic surgery.

METHODS

We performed a retrospective review of 424 children with cerebral palsy who had been born between 1976 and 1994. The children were divided into three groups: Group 1 comprised 122 patients who were managed throughout the entire study period according to best-practice guidelines in orthopaedics, Group 2 comprised 170 patients who were similarly managed but with input from gait analysis, and Group 3 comprised 132 patients who had gait analysis and also received botulinum toxin type-A injections. We analyzed the prevalence of orthopaedic surgical procedures at different ages (three to nine years) and the time to the first surgical procedure.

RESULTS

The progression to orthopaedic surgery was significantly different among the three groups (p < 0.0001). The proportion of patients who had undergone at least one surgical procedure by the age of seven years was 52% (sixty-four of 122) for Group 1, 27% (forty-six of 170) for Group 2, and 10% (thirteen of 132) for Group 3. There was a delay in surgery in Group 2 as compared with Group 1 (p < 0.00001 at seven, eight, and nine years of age) and a significant decrease in the prevalence of orthopaedic surgical procedures for Group 3 as compared with Group 1 (p < 0.00001 at four to eight years of age) and Group 2 (p < 0.0025 at four to nine years of age).

CONCLUSIONS

In the treatment of children who have cerebral palsy, the introduction of gait analysis increases the age of the first orthopaedic surgical procedure and botulinum toxin type-A treatment delays and reduces the frequency of surgical procedures.

摘要

背景

脑瘫患儿的非手术治疗方法，包括物理治疗和矫形器治疗，其局限性通常会导致骨科手术干预。本研究的目的是评估步态分析和A型肉毒杆菌毒素注射对骨科手术时机、发生率和频率的影响。

方法

我们对1976年至1994年出生的424例脑瘫患儿进行了回顾性研究。这些患儿被分为三组：第1组包括122例患者，在整个研究期间按照骨科最佳实践指南进行管理；第2组包括170例患者，管理方式类似，但有步态分析的参与；第3组包括132例患者，进行了步态分析并接受了A型肉毒杆菌毒素注射。我们分析了不同年龄（3至9岁）时骨科手术的发生率以及首次手术的时间。

结果

三组之间向骨科手术的进展存在显著差异（p < 0.0001）。第1组中，7岁时至少接受过一次手术的患者比例为52%（122例中的64例）；第2组为27%（170例中的46例）；第3组为10%（132例中的13例）。与第1组相比，第2组的手术延迟（7岁、8岁和9岁时p < 0.00001），与第1组相比，第3组骨科手术的发生率显著降低（4至8岁时p < 0.00001），与第2组相比也显著降低（4至9岁时p < 0.0025）。