Aktaş Erdem, Ömeroğlu Hakan
Department of Orthopedics and Traumatology, TOBB University of Economics and Technology, Faculty of Medicine, 06510 Söğütözü, Ankara, Turkey.
Eklem Hastalik Cerrahisi. 2019 Aug;30(2):155-62. doi: 10.5606/ehc.2019.65453.
This study aims to evaluate the clinical outcomes of children with spastic type cerebral palsy (CP) treated with botulinum toxin type A (BoNT-A) injection for lower limb contracture and the influence of age, gender, functional level and degree of initial contracture on treatment outcomes.
Clinical records at pre-BoNT-A injection and post-BoNT-A injections of 153 sessions of a total of 118 consecutive children (67 boys, 51 girls; mean age 5.9±2.6 years; range, 2.5-16 years) were retrospectively evaluated. Degrees of pre- and post-injection contracture were evaluated. Post-injection supplemental casting for 10 days was recorded in all cases. Less than 20° of hip flexion contracture, more than 30° of hip abduction, a negative prone Ely test, less than 50° of popliteal angle and at least 5° of ankle dorsiflexion values at post-injection were accepted as sufficient clinical improvement.
Sufficient post-injection range of motion (ROM) was observed in 80% of cases with hip flexion contracture, in 45% of cases with hip adduction contracture, in 84% of cases with knee flexion contracture and in 77% of cases with ankle equinus contracture. Prone Ely test that was positive in 60% of cases with knee extension contracture was negative at post-injection. Improvement in contractures were prominent in children with lesser degree initial contractures.
Botulinum toxin type A injection increases ROM in hip, knee and ankle joint contractures in CP. Although age, gender and functional level may influence the clinical outcomes, pre-treatment level of contracture is the main determinant in improvement in ROM at post-injection.
本研究旨在评估A型肉毒毒素（BoNT-A）注射治疗痉挛型脑瘫（CP）患儿下肢挛缩的临床疗效，以及年龄、性别、功能水平和初始挛缩程度对治疗效果的影响。
回顾性评估了118例连续儿童（67例男孩，51例女孩；平均年龄5.9±2.6岁；范围2.5 - 16岁）共153次BoNT-A注射前后的临床记录。评估注射前和注射后的挛缩程度。记录所有病例注射后为期10天的辅助石膏固定情况。注射后髋关节屈曲挛缩小于20°、髋关节外展大于30°、俯卧位艾利试验阴性、腘窝角小于50°以及踝关节背屈至少5°被视为临床改善充分。
髋关节屈曲挛缩病例中80%、髋关节内收挛缩病例中45%、膝关节屈曲挛缩病例中84%以及踝关节马蹄足挛缩病例中77%在注射后观察到足够的活动范围（ROM）。膝关节伸展挛缩病例中60%阳性的俯卧位艾利试验在注射后转为阴性。初始挛缩程度较轻的儿童挛缩改善显著。
A型肉毒毒素注射可增加CP患儿髋关节、膝关节和踝关节挛缩的ROM。尽管年龄、性别和功能水平可能影响临床疗效，但注射前的挛缩程度是注射后ROM改善的主要决定因素。
