Grigoriu Anca-Irina, Dinomais Mickael, Rémy-Néris Olivier, Brochard Sylvain
University Hospital of Brest, Rehabilitation Department, Brest, France.
LUNAM, University of Angers, University Hospital of Angers, Rehabilitation Department, Angers, France; LUNAM, University of Angers, Angers Laboratory for Research in Engineering Systems (LARIS)-UPRES EA, Angers, France.
Arch Phys Med Rehabil. 2015 Nov;96(11):2067-78.e1. doi: 10.1016/j.apmr.2015.05.002. Epub 2015 May 14.
To conduct a systematic review of the impact of different injection-guiding techniques on the effectiveness of botulinum toxin type A (BoNT-A) for the treatment of focal spasticity and dystonia.
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Two reviewers independently selected studies based on predetermined inclusion criteria.
Data relating to the aim were extracted. Methodological quality was graded independently by 2 reviewers using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs. Level of evidence was determined using the modified Sackett scale.
Ten studies were included. Seven were randomized. There was strong evidence (level 1) that instrumented guiding (ultrasonography [US], electrical stimulation [ES], electromyogram [EMG]) was more effective than manual needle placement for the treatment of spasmodic torticollis, upper limb spasticity, and spastic equinus in patients with stroke, and spastic equinus in children with cerebral palsy. Three studies provided strong evidence (level 1) of similar effectiveness of US and ES for upper and lower limb spasticity in patients with stroke, and spastic equinus in children with cerebral palsy, but there was poor evidence or no available evidence for EMG or other instrumented techniques.
These results strongly recommend instrumented guidance of BoNT-A injection for the treatment of spasticity in adults and children (ES or US), and of focal dystonia such as spasmodic torticollis (EMG). No specific recommendations can be made regarding the choice of instrumented guiding technique, except that US appears to be more effective than ES for spastic equinus in adults with stroke.
对不同注射引导技术对A型肉毒毒素（BoNT-A）治疗局灶性痉挛和肌张力障碍有效性的影响进行系统评价。
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两名评价者根据预先确定的纳入标准独立选择研究。
提取与研究目的相关的数据。两名评价者分别使用物理治疗证据数据库随机对照试验（RCT）评估量表和非RCT的唐斯和布莱克评价工具对方法学质量进行分级。使用改良的萨克特量表确定证据水平。
纳入10项研究。7项为随机对照试验。有强有力的证据（1级）表明，对于中风患者的痉挛性斜颈、上肢痉挛和马蹄内翻足，以及脑瘫患儿的马蹄内翻足，仪器引导（超声[US]、电刺激[ES]、肌电图[EMG]）比手动进针更有效。三项研究提供了强有力的证据（1级），表明超声和电刺激治疗中风患者的上肢和下肢痉挛以及脑瘫患儿的马蹄内翻足效果相似，但关于肌电图或其他仪器技术的证据不足或无可用证据。
这些结果强烈推荐在成人和儿童中使用仪器引导注射BoNT-A治疗痉挛（电刺激或超声），以及治疗局灶性肌张力障碍，如痉挛性斜颈（肌电图）。除了对于中风成人患者的马蹄内翻足，超声似乎比电刺激更有效外，关于仪器引导技术的选择无法给出具体建议。
