Yang Eun Joo, Rha Dong-Wook, Kim Hyun Woo, Park Eun Sook
Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Arch Phys Med Rehabil. 2008 Nov;89(11):2108-13. doi: 10.1016/j.apmr.2008.04.019.
To compare the effects of botulinum toxin type A (BTX-A) injection into the hip adductor muscles on hip displacement with soft-tissue surgery and assess the factors related to a favorable outcome after intervention in children with bilateral spastic cerebral palsy (CP).
Retrospective chart review with regard to radiographic findings.
University hospital.
Children with CP (N=194).
BTX-A injection and soft-tissue surgery into the hip adductor muscles.
The Reimers hip migration percentage (MP).
Sixty-nine children did not receive any therapeutic intervention for hip displacement, whereas 60 children underwent soft-tissue surgery and 65 children took BTX-A injection for the spasticity of their hip muscles. MP was measured on each radiograph of the pelvis. The annual change of MP was improved in both the soft-tissue surgery and BTX-A groups, whereas it worsened in the nonintervention group. The annual improvement of MP in the BTX-A group did not differ significantly from that of the soft-tissue surgery group. The improvement in hip displacement after therapeutic intervention was greater in young children and high-functioning groups compared with older children and low-functioning groups. Hip displacement was progressive in the severely hip subluxated group despite therapeutic intervention.
Comparable effects of BTX-A injection to soft-tissue surgery in our study suggest that BTX-A injection, if timely reinjected, may replace soft-tissue surgery as a prophylactic procedure against progressive hip subluxation or dislocation in children. Age at intervention, functional level, and initial MP before therapeutic intervention were the factors affecting the outcomes.
比较A型肉毒杆菌毒素（BTX-A）注射至髋内收肌对髋关节移位的影响与软组织手术，并评估双侧痉挛型脑瘫（CP）患儿干预后良好预后的相关因素。
关于影像学检查结果的回顾性图表分析。
大学医院。
CP患儿（N = 194）。
BTX-A注射及髋内收肌软组织手术。
赖默斯髋关节移位百分比（MP）。
69例患儿未接受任何针对髋关节移位的治疗干预，60例患儿接受了软组织手术，65例患儿因髋部肌肉痉挛接受了BTX-A注射。在骨盆的每张X线片上测量MP。软组织手术组和BTX-A组的MP年度变化均有所改善，而未干预组则恶化。BTX-A组MP的年度改善与软组织手术组无显著差异。与大龄儿童和低功能组相比，治疗干预后幼儿和高功能组的髋关节移位改善更大。尽管进行了治疗干预，严重髋关节半脱位组的髋关节移位仍在进展。
本研究中BTX-A注射与软组织手术效果相当，提示BTX-A注射若及时再次注射，可能替代软组织手术，作为预防儿童进行性髋关节半脱位或脱位的一种预防性措施。干预时的年龄、功能水平以及治疗干预前的初始MP是影响预后的因素。
