Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219, USA.
J Bone Joint Surg Am. 2010 Sep 15;92(12):2171-7. doi: 10.2106/JBJS.I.00499.
Botulinum toxin A is used to treat contractures in children with spasticity by temporarily interfering with neural transmission at the motor end plate. In infants with brachial plexus palsy, posterior shoulder subluxation and dislocation are the result of muscle imbalance, in which neurologic recovery is evolving, and spasticity is not a deforming force. We postulated that temporary weakening of the shoulder internal rotator muscles with botulinum toxin A would facilitate reduction of the glenohumeral joint in such infants with early posterior shoulder subluxation or dislocation.
Thirty-five infants with posterior subluxation or dislocation of the shoulder due to brachial plexus palsy were treated with botulinum toxin A between January 1999 and December 2006, and were followed for a minimum period of one year. Records were reviewed for the severity of the palsy, age at time of treatment, recurrence of subluxation or dislocation, and the subsequent need for further treatment to reduce the glenohumeral joint.
The average age at the time of shoulder reduction and botulinum toxin-A injection was 5.7 months. Six patients had a second injection. Reduction of the shoulder was maintained in twenty-four (69%) of the thirty-five patients. There were no complications related to the use of botulinum toxin A.
Although there may be specific risks associated with its use, botulinum toxin-A injection into the internal rotator muscles is a useful adjunct to the treatment of early posterior subluxation or dislocation of the shoulder in infants with neonatal brachial plexus palsy, and may help to avoid the need for open surgical procedures to restore or maintain shoulder reduction.
肉毒杆菌毒素 A 用于通过暂时干扰运动终板处的神经传递来治疗痉挛性儿童的挛缩。在患有臂丛神经麻痹的婴儿中，由于肌肉失衡，后肩盂肱关节半脱位和脱位是神经恢复的结果，而痉挛并不是一种变形力。我们推测，通过肉毒杆菌毒素 A 暂时削弱肩内旋肌，可有助于减少早期后肩盂肱关节半脱位或脱位的婴儿的盂肱关节。
1999 年 1 月至 2006 年 12 月，我们对 35 例因臂丛神经麻痹导致后肩盂肱关节半脱位或脱位的婴儿使用肉毒杆菌毒素 A 进行治疗，并至少随访一年。我们对麻痹的严重程度、治疗时的年龄、半脱位或脱位的复发情况以及进一步减少盂肱关节的后续治疗需求进行了回顾性分析。
肩部复位和肉毒杆菌毒素 A 注射的平均年龄为 5.7 个月。6 例患者接受了第二次注射。35 例患者中的 24 例（69％）保持了肩部复位。未出现与肉毒杆菌毒素 A 应用相关的并发症。
尽管其使用可能存在特定风险，但将肉毒杆菌毒素 A 注射到内旋肌中是治疗新生儿臂丛神经麻痹婴儿早期后肩盂肱关节半脱位或脱位的一种有用方法，并且可以帮助避免需要开放性手术来恢复或维持肩部复位。
