Orthopaedic Department, The Royal Children's Hospital, Parkville, Victoria, Australia.
Dev Med Child Neurol. 2012 Aug;54(8):743-7. doi: 10.1111/j.1469-8749.2012.04340.x. Epub 2012 Jun 12.
To study the long-term impact of 3 years of botulinum toxin A (BoNT-A) injections and abduction bracing on hip development in children with bilateral spastic cerebral palsy (CP). We wanted to know if early treatment improved hip development and reduced the need for surgery.
A long-term review of hip morphology and surgery requirements in children who participated in a multicentre, randomized controlled trial. The trial investigated short-term effects of BoNT-A injections combined with an abduction brace, compared with usual care, on hip displacement in children with bilateral spastic CP.
Forty-six children with bilateral spastic CP (31 males, 15 females; 10 with diplegia, 36 with quadriplegia; mean age at enrolment of 3 y 2 mo, mean age at most recent clinical review 13 y 11 mo [range 10 y 6 mo-16 y 8 mo]; three children in Gross Motor Function Classification System level II, 11 in level III, 20 in level IV, 12 in level V) were followed for a mean of 10 years 10 months from recruitment to the trial. Mean migration percentage was 15.9% in the BoNT-A group and 15.2% in the comparison group (t = 0.26, p = 0.79). Eighty-nine percent of hips in the treatment group and 91% hips in the comparison group had satisfactory development, using a valid scale (Mann-Whitney U test = 867.50, z = -1.59, p = 0.11). Forty children had preventive surgery (21 treatment group, 19 comparison group) and 18 children had reconstructive surgery (10 treatment, 8 comparison).
In children with bilateral spastic CP, early treatment with BoNT-A and hip abduction bracing does not reduce the need for surgery or improve hip development at skeletal maturity.
研究 3 年肉毒毒素 A（BoNT-A）注射和外展支具对双侧痉挛性脑瘫（CP）儿童髋关节发育的长期影响。我们想知道早期治疗是否能改善髋关节发育并减少手术需求。
对参加多中心随机对照试验的儿童进行髋关节形态和手术需求的长期回顾。该试验研究了 BoNT-A 注射联合外展支具与常规护理对双侧痉挛性 CP 儿童髋关节移位的短期影响。
46 例双侧痉挛性 CP 患儿（男 31 例，女 15 例；双瘫 10 例，四肢瘫 36 例；入组时平均年龄 3 岁 2 个月，最近临床随访时平均年龄 13 岁 11 个月[10 岁 6 个月至 16 岁 8 个月]；3 例患儿处于粗大运动功能分级系统 II 级，11 例处于 III 级，20 例处于 IV 级，12 例处于 V 级）自招募入组到试验随访时间平均为 10 年 10 个月。BoNT-A 组的迁移百分比为 15.9%，对照组为 15.2%（t = 0.26，p = 0.79）。治疗组 89%的髋关节和对照组 91%的髋关节发育良好，采用有效量表（Mann-Whitney U 检验=867.50，z = -1.59，p = 0.11）。40 例患儿行预防性手术（治疗组 21 例，对照组 19 例），18 例患儿行重建性手术（治疗组 10 例，对照组 8 例）。
对于双侧痉挛性 CP 患儿，早期使用 BoNT-A 和髋关节外展支具治疗并不能减少手术需求或改善骨骼成熟时的髋关节发育。
