Büyükavcı Raikan, Büyükavcı Mehmet Akif
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Inonu University, Malatya, Turkey.
Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Faculty of Medicine, Inonu University, Malatya, Turkey.
Acta Neurol Belg. 2018 Sep;118(3):429-433. doi: 10.1007/s13760-018-0929-5. Epub 2018 Apr 24.
The aim of this study was to detect effects of ultrasound-guided botulinum toxin type-A (US-guided BoNT-A) injections prepared according to lower extremity innervation zones on spasticity and motor function in 3-16 years children with diplegic and hemiplegic spastic cerebral palsy. This study included 25 patients between 3 and 16 years of age who admitted to our clinic in 2017, were being followed in our clinic with a diagnosis of cerebral palsy, had BoNT-A injections due to lower extremity spasticity. The US-guided BoNT-A injections were administered into the spastic muscles using a specific approach according to innervation zones of muscle. Modified Ashworth Scale (MAS) and Gross Motor Functional Classification System (GMFCS) were assessed at the baseline, and 4 and 12 weeks after the BoNT-A injections. Minimum and maximum ages of the patients were 45 and 192 months, and gender distribution was 8 females and 17 males. Significant decreases in the MAS scores of the knee and ankle tones were measured 4 and 12 weeks after the BoNT-A injection when compared to the baseline scores (p < 0.025). Hip muscle tonus only decreased 12 weeks after the injection (p < 0.025). In parallel with a reduction in spasticity GMFCS improved from 3 to 2 in the 4th and 12th weeks. US-guided BoNT-A injections with Euro-musculus approach is a practical and effective method to perform injections into proper points of proper muscles in children with spastic cerebral palsy.
本研究旨在检测根据下肢神经支配区域制备的超声引导下A型肉毒毒素（US-guided BoNT-A）注射对3至16岁双瘫和偏瘫痉挛型脑瘫患儿痉挛状态和运动功能的影响。本研究纳入了25例年龄在3至16岁之间的患者，这些患者于2017年入住我院，因脑瘫在我院接受随访，因下肢痉挛接受了BoNT-A注射。根据肌肉的神经支配区域，采用特定方法将US-guided BoNT-A注射到痉挛肌肉中。在基线、BoNT-A注射后4周和12周时评估改良Ashworth量表（MAS）和粗大运动功能分级系统（GMFCS）。患者的最小和最大年龄分别为45个月和192个月，性别分布为8名女性和17名男性。与基线评分相比，BoNT-A注射后4周和12周时，膝部和踝部肌张力的MAS评分显著降低（p<0.025）。髋部肌肉张力仅在注射后12周降低（p<0.025）。随着痉挛状态的减轻，GMFCS在第4周和第12周从3级改善到2级。采用欧洲肌肉注射法进行US-guided BoNT-A注射是一种在痉挛型脑瘫患儿中向合适肌肉的合适部位进行注射的实用且有效的方法。
