Motta Francesco, Antonello Clara E, Stignani Cecilia
Department of Pediatric Orthopedics, V. Buzzi Children's Hospital, Milano, Italy.
J Pediatr Orthop. 2009 Oct-Nov;29(7):817-21. doi: 10.1097/BPO.0b013e3181b76a01.
Different studies show the efficacy of intrathecal baclofen therapy (ITB) in patients with secondary dystonia because of cerebral palsy. These studies only report improvements related to dystonia reduction; however, none of them have assessed whether such benefit is reflected in limb function. The purpose of our study is to determine whether the effects ITB therapy in patients with secondary dystonia to cerebral palsy, in addition to reducing dystonia, may also improve upper limb function.
Eleven patients with secondary dystonia, classified as levels 3 and 4 of the Gross Motor Function Classification System, were treated with ITB. The mean age at implant was 11.3 (SD+/-3.02) years.Before treatment and 12 months after implant, the patients were evaluated by the Melbourne Assessment of Unilateral Upper Limb and the Barry Albright scale to assess upper limb function and dystonia, respectively.
We found a statistically significant improvement in both scales. The Melbourne scale total percentage score, for both limbs, increased in all patients (P<0.05). Dystonia assessed by the Barry Albright scale scale decreased significantly by 15% from baseline to 12 months follow-up (P<0.05).
In patients with secondary dystonia treated with ITB, functional improvement of the upper limbs was observed in addition to dystonia reduction. In patients with secondary dystonia, ITB is a treatment that aims to achieve a general reduction of dystonia; this study want to show the influence that this reduction has to functional ability of patient.
Therapeutic study: level 4.
不同研究表明鞘内注射巴氯芬疗法（ITB）对因脑瘫导致继发性肌张力障碍的患者有效。这些研究仅报告了与肌张力障碍减轻相关的改善情况；然而，它们均未评估这种益处是否体现在肢体功能上。我们研究的目的是确定ITB疗法对脑瘫继发性肌张力障碍患者的影响，除了减轻肌张力障碍外，是否还能改善上肢功能。
11例继发性肌张力障碍患者，根据粗大运动功能分类系统分为3级和4级，接受ITB治疗。植入时的平均年龄为11.3（标准差±3.02）岁。在治疗前和植入后12个月，分别通过墨尔本单上肢评估和巴里·奥尔布赖特量表对患者进行评估，以评估上肢功能和肌张力障碍。
我们发现两个量表均有统计学意义的改善。所有患者双上肢的墨尔本量表总分百分比均增加（P<0.05）。通过巴里·奥尔布赖特量表评估的肌张力障碍从基线到随访12个月时显著下降了15%（P<0.05）。
在接受ITB治疗的继发性肌张力障碍患者中，除了肌张力障碍减轻外，还观察到上肢功能改善。对于继发性肌张力障碍患者，ITB是一种旨在全面减轻肌张力障碍的治疗方法；本研究旨在表明这种减轻对患者功能能力的影响。
治疗性研究：4级。
