Basciani M, Intiso D
Department of Rehabilitation, IRCCS, Casa Sollievo della Sofferenza, S. Giovanni Rotondo, FG, Italy.
Pediatr Rehabil. 2006 Apr-Jun;9(2):165-70. doi: 10.1080/13693780500402229.
Electrical stimulation, physical therapy and occupational therapy remain the main treatment for children with upper brachial plexus palsy (UBPP), when surgery has been excluded. A pilot study was undertaken to investigate whether botulinum toxin type A (BoNT-A) and plaster casting, as adjunct to the physical therapy, decreased muscle contracture and improved the position and function of the impaired arm.
Twenty-two children (mean age 5.6 +/- 3.4 years) with mild UBPP who previously underwent serial cast treatment, unsuccessfully, were enrolled. Neurological impairment and functional status were quantified using Medical Research Council (MRC) and Mallet scales and the Nine-Hole Peg Test (NHPT). Elbow extension was measured using a goniometer. Biceps brachii, brachialis, pronator teres and pectoralis major muscles were injected with 22 units kg(-1) BoNT-A (Dysport, Ipsen). After injection, the treated arm was fixed with a plaster cast and progressively lengthened over 14 days. The cast was maintained for 30 days. Assessments of elbow extension, MRC, Mallet Scale and NHPT were made at baseline, 3, 6 and 12 months.
After BoNT-A injection, children had significant improvement of active elbow extension (15.5 degrees +/- 17.1 at 12 months after injection, compared with 42.0 degrees +/- 10.4 at baseline; p < 0.001). NPHT scores improved significantly over the 12 months (51.1 +/- 21.8 seconds compared with 56.7 +/- 19.3 seconds at baseline, p < 0.01). MRC and Mallet scale scores of the paretic muscles were unchanged.
The children showed a reduction in muscular contracture and improvements of the arm position and elbow extension. The data support the use of BoNT-A and plaster casting as an adjunct to physical therapy, in the treatment of children with mild UBPP.
当排除手术治疗后，电刺激、物理治疗和职业治疗仍是治疗上臂丛神经麻痹（UBPP）患儿的主要方法。本项初步研究旨在探讨A型肉毒毒素（BoNT-A）和石膏固定作为物理治疗的辅助手段，是否能减少肌肉挛缩，并改善患侧手臂的位置和功能。
纳入22例轻度UBPP患儿（平均年龄5.6±3.4岁），这些患儿此前接受过系列石膏治疗但未成功。使用医学研究委员会（MRC）和马利特量表以及九孔插钉试验（NHPT）对神经功能缺损和功能状态进行量化。使用角度计测量肘关节伸展度。向肱二头肌、肱肌、旋前圆肌和胸大肌注射22单位/千克的BoNT-A（Dysport，益普生公司）。注射后，用石膏固定治疗侧手臂，并在14天内逐渐延长。石膏固定维持30天。在基线、3个月、6个月和12个月时对肘关节伸展度、MRC、马利特量表和NHPT进行评估。
注射BoNT-A后，患儿的主动肘关节伸展度有显著改善（注射后12个月时为15.5°±17.1°，而基线时为42.0°±10.4°；p<0.001）。在12个月期间，NHPT评分有显著改善（51.1±21.8秒，而基线时为56.7±19.3秒，p<0.01）。患侧肌肉的MRC和马利特量表评分未发生变化。
患儿肌肉挛缩减轻，手臂位置和肘关节伸展度得到改善。这些数据支持将BoNT-A和石膏固定作为物理治疗的辅助手段，用于治疗轻度UBPP患儿。
