Blackmore A M, Boettcher-Hunt E, Jordan M, Chan M D Y
The Centre for Cerebral Palsy, Mount Lawley, Western Australia, Australia.
Dev Med Child Neurol. 2007 Oct;49(10):781-90. doi: 10.1111/j.1469-8749.2007.00781.x.
This systematic review examines the effects of casting, either alone or in combination with botulinum toxin type A (BTX-A), on equinus in children with cerebral palsy (CP). Comparisons are made between casting alone and no treatment, between casting alone and BTX-A alone, between combined casting and BTX-A and each treatment by itself, and between casting followed by BTX-A and BTX-A followed by casting. A search of PUBMED, CINAHL, Proquest Health and Medical Complete, Cochrane Database of Systematic reviews, Physiotherapy Evidence Database (PEDro), OTseeker, Database of Reviews of Effectiveness (DARE), and Infotrieve yielded 184 citations. Articles were included in the review if they reported the effects of an intervention using casting for equinus in particpants with CP aged 20 or less, if they appeared in a peer-reviewed scholarly journal in 1970 or later, with no language restriction, and if casting was not used in conjunction with surgery. Twenty-two articles were selected, including seven randomized controlled trials (RCTs). There is little evidence that casting is superior to no casting, but the protocols of casting in current use have not been compared with no treatment in any RCT. There is no strong and consistent evidence that combining casting and BTX-A is superior to using either intervention alone, or that either casting or BTX-A is superior to the other immediately after treatment. Finally, there is no evidence that order of treatment (casting before BTX-A versus BTX-A before casting) affects outcome. Much of the evidence both for and against differences is weak, and results may be explained by methodological limitations. Future research needs to use adequate sample sizes, long-term follow-ups, and broader and more global measures.
本系统评价研究了单独使用石膏固定或联合A型肉毒毒素（BTX-A）对脑瘫（CP）患儿马蹄足的影响。比较了单独使用石膏固定与不治疗、单独使用石膏固定与单独使用BTX-A、联合使用石膏固定和BTX-A与各自单独治疗、先使用石膏固定后使用BTX-A与先使用BTX-A后使用石膏固定的效果。检索了PubMed、CINAHL、Proquest健康与医学全文数据库、Cochrane系统评价数据库、物理治疗证据数据库（PEDro）、OTseeker、有效性评价数据库（DARE）和Infotrieve，共获得184条引文。如果文章报告了对20岁及以下CP患儿马蹄足使用石膏固定进行干预的效果，发表于1970年或之后的同行评审学术期刊，无语言限制，且未与手术联合使用石膏固定，则纳入本评价。共选择了22篇文章，其中包括7项随机对照试验（RCT）。几乎没有证据表明石膏固定优于不进行石膏固定，但目前使用的石膏固定方案在任何RCT中均未与不治疗进行比较。没有强有力且一致的证据表明联合使用石膏固定和BTX-A优于单独使用任何一种干预措施，也没有证据表明在治疗后立即使用石膏固定或BTX-A一方优于另一方。最后，没有证据表明治疗顺序（先使用石膏固定后使用BTX-A与先使用BTX-A后使用石膏固定）会影响治疗结果。支持或反对差异的许多证据都很薄弱，结果可能由方法学局限性来解释。未来的研究需要使用足够的样本量、长期随访以及更广泛和全面的测量方法。
