肉毒毒素 A 注射小腿肌肉对脑瘫儿童膝反张的影响。
The influence of botulinum toxin A injections into the calf muscles on genu recurvatum in children with cerebral palsy.
机构信息
Department of Orthopaedic and Trauma Surgery, Heidelberg University Clinics, Heidelberg, Germany.
出版信息
Clin Orthop Relat Res. 2013 Jul;471(7):2327-32. doi: 10.1007/s11999-013-2897-7. Epub 2013 Mar 6.
BACKGROUND
With cerebral palsy (CP), an equinus deformity may lead to genu recurvatum. Botulinum toxin A (BtA) injection into the calf muscles is a well-accepted treatment for dynamic equinus deformity.
QUESTIONS/PURPOSES: The purpose of this study was to determine whether BtA injections into the calf muscles to decrease equinus would decrease coexisting genu recurvatum in children with diplegic CP.
METHODS
In a retrospective study, 13 children (mean age, 5 years) with spastic diplegic CP showing equinus and coexisting primary genu recurvatum, who were treated with BtA injections into the calf muscles, were included. Evaluations were done before and 6 and 18 weeks after intervention using three-dimensional gait analysis and clinical examinations according to a standardized protocol. Basic statistical analyses (power analysis, ANOVA) were performed to compare genu recurvatum before treatment and at 6 and 18 weeks after injection with BtA.
RESULTS
During stance phase, maximum ankle dorsiflexion was increased substantially from -3.0° ± 14.3° before to 6.2° ± 14.2° 6 weeks after the injections. Despite this, with the numbers available, the amount of recurvatum in stance did not improve with treatment at either 6 or 18 weeks. There was significant improvement of knee hyperextension during stance phase of 6.2° between baseline and 18 weeks after BtA injection, but a genu recurvatum was still present in most patients.
CONCLUSIONS
Despite improvement of ankle dorsiflexion after injection with BtA, genu recurvatum did not show relevant improvement at 6 or 18 weeks after injection with the numbers available. Because knee hyperextension remained in most patients, other factors leading to genu recurvatum should be taken into consideration. In addition, a botulinum toxin-induced weakness of the gastrocnemius may explain why recurvatum gait was not significantly reduced.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
脑瘫（CP）可导致马蹄内翻足畸形，引起膝关节过伸。肉毒毒素 A（BtA）注射小腿肌肉是治疗动态马蹄内翻足畸形的有效方法。
问题/目的：本研究旨在确定 BtA 注射小腿肌肉以减少马蹄内翻是否会降低痉挛性双瘫 CP 儿童并存的膝关节过伸。
方法
在一项回顾性研究中，纳入了 13 名患有痉挛性双瘫 CP 且存在马蹄内翻和并存的原发性膝关节过伸的儿童（平均年龄 5 岁），他们接受了 BtA 注射小腿肌肉治疗。使用三维步态分析和根据标准化方案进行的临床检查，在干预前和干预后 6 周和 18 周进行评估。进行了基本的统计分析（功效分析、方差分析），以比较 BtA 注射治疗前后膝关节过伸的情况。
结果
在站立相期间，最大踝关节背屈从治疗前的-3.0°±14.3°显著增加到治疗后的 6.2°±14.2°。尽管如此，根据现有数据，治疗后 6 周和 18 周时，站立位的过伸量并没有改善。在 BtA 注射后 6 周和 18 周，站立相时膝关节过伸的程度显著改善了 6.2°，但大多数患者仍存在膝关节过伸。
结论
尽管 BtA 注射后踝关节背屈得到改善，但根据现有数据，注射后 6 周和 18 周时膝关节过伸并没有得到相关改善。由于大多数患者仍存在膝关节过伸，因此应考虑导致膝关节过伸的其他因素。此外，肉毒毒素引起的比目鱼肌无力可能解释了为什么过伸步态没有明显减少。
证据水平
IV 级，治疗研究。欲了解完整的证据水平描述，请参见作者指南。
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