肉毒毒素治疗产科臂丛神经麻痹的运动性失衡。
Botulinum toxin for the treatment of motor imbalance in obstetrical brachial plexus palsy.
机构信息
Toronto, Ontario, Canada From the Division of Plastic Surgery, Hospital for Sick Children; and the Department of Surgery, University of Toronto.
出版信息
Plast Reconstr Surg. 2013 Jun;131(6):1307-1315. doi: 10.1097/PRS.0b013e31828bd487.
BACKGROUND
Residual muscle imbalance is a common problem affecting obstetrical brachial plexus palsy patients. The goal of this study was to examine the efficacy of botulinum toxin type A (Botox) in improving this muscle imbalance.
METHODS
The authors retrospectively reviewed obstetrical brachial plexus palsy patients treated with Botox for muscle imbalance as an isolated procedure. Outcomes were the change in Active Movement Scale scores from pre-Botox scores to scores at 1 month after Botox and 1 year after Botox.
RESULTS
Twenty-seven patients were included, 19 treated for shoulder imbalance and eight treated for elbow imbalance. Active Movement Scale scores (mean±SD) for shoulder external rotation improved from 0.6±1.0 before Botox to 2.6±2.14 (p<0.01) at 1 month after Botox, and declined to 1.3±1.2 (p<0.01) at 1 year after Botox. Scores for elbow flexion were 3.3±2.1 before Botox, unchanged at 4.4±1.8 (p=0.07) 1 month after Botox, and improved to 5.8±0.5 (p<0.01) at 1 year after Botox. Scores for elbow supination were 2.9±1.7 before Botox and 3.4±1.5 (p=0.2) at 1 month after Botox, and improved to 3.9±2.0 (p<0.01) at 1 year after Botox.
CONCLUSIONS
Botox for shoulder movement imbalance produces improvement in external rotation that is not sufficiently sustained over time to be of clinical benefit. However, Botox for elbow movement imbalance produces a sustained and clinically useful improvement.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
背景
残余肌肉不平衡是影响产瘫患者的常见问题。本研究旨在研究 A 型肉毒毒素（Botox）在改善这种肌肉不平衡中的疗效。
方法
作者回顾性分析了接受 Botox 治疗肌肉不平衡的产瘫患者，该治疗为单一程序。结果为从 Botox 前的主动运动量表评分（AMM）到 Botox 后 1 个月和 1 年后的评分变化。
结果
共纳入 27 例患者，19 例肩部失平衡，8 例肘部失平衡。肩部外旋的 AMM 评分（均值±标准差）从 Botox 前的 0.6±1.0 提高到 Botox 后 1 个月的 2.6±2.14（p<0.01），并在 Botox 后 1 年下降到 1.3±1.2（p<0.01）。肘屈曲的评分在 Botox 前为 3.3±2.1，Botox 后 1 个月时不变，为 4.4±1.8（p=0.07），在 Botox 后 1 年改善到 5.8±0.5（p<0.01）。肘旋前的评分在 Botox 前为 2.9±1.7，Botox 后 1 个月时为 3.4±1.5（p=0.2），并在 Botox 后 1 年改善到 3.9±2.0（p<0.01）。
结论
Botox 治疗肩部运动失平衡可改善外旋，但这种改善不能持续足够长时间而具有临床意义。然而，Botox 治疗肘部运动失平衡可产生持续且具有临床意义的改善。
临床问题/证据水平：治疗性，IV。
Zotero 插件