Department of Rehabilitation Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
Dev Med Child Neurol. 2010 Jun;52(6):517-28. doi: 10.1111/j.1469-8749.2009.03607.x. Epub 2010 Feb 12.
To give an overview of indications for the use of botulinum toxin A (BoNT-A) treatment for children with obstetric brachial plexus injury (OBPI), and to present the best available evidence of the effectiveness of this treatment.
Searches were performed in Cinahl, Cochrane Library, Embase, PubMed, and Web of Science, using the keywords 'botulinum' and 'plexus', to identify articles reporting on the use of BoNT-A as a treatment for children with OBPI. Studies found through the references of related articles were also selected.
Ten full-text papers and six congress abstracts were included, involving 343 children. Four groups of indications could be identified: internal rotation/adduction contracture of the shoulder, limited active elbow flexion, limited active elbow extension, and pronation contracture of the lower arm. Overall, positive results were reported for all except the indication for limited active elbow extension. However, only one study was comparative in nature; all others were classified as having a low level of evidence. There was a large variation in outcome measures.
To provide better evidence for the already partly promising results of BoNT-A treatment for children with OBPI, multicentre randomized controlled trials are needed.
概述 A 型肉毒毒素（BoNT-A）治疗产伤性臂丛神经损伤（OBPI）患儿的适应证，并介绍该治疗方法的有效性的最佳现有证据。
在 Cinahl、Cochrane 图书馆、Embase、PubMed 和 Web of Science 中使用“botulinum”和“plexus”这两个关键词进行检索，以确定报道 BoNT-A 治疗 OBPI 患儿的文章。还选择了通过相关文章参考文献找到的研究。
共纳入 10 篇全文文献和 6 篇大会摘要，涉及 343 名儿童。可确定以下 4 组适应证：肩部内旋/内收挛缩、主动肘屈受限、主动肘伸受限和前臂旋前挛缩。总体而言，除了主动肘伸受限这一适应证外，所有适应证均报告了阳性结果。然而，只有一项研究具有可比性；其他所有研究均归类为低证据水平。研究结果的衡量指标差异很大。
为了为 BoNT-A 治疗 OBPI 患儿的部分已有良好结果提供更好的证据，需要进行多中心随机对照试验。
