de Coulon Geraldo, Canavese Federico, Armand Stéphane, Bonnefoy-Mazure Alice, Merlini Laura
Pediatric Orthopaedic Unit, Department of Child and Adolescent, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
Lille University Centre, Jeanne de Flandre Hospital, Department of Pediatric Orthopedic Surgery, Lille, France.
J Pediatr Orthop B. 2022 Jan 1;31(1):e81-e84. doi: 10.1097/BPB.0000000000000816.
Intramuscular injections of Botulinum Toxin Type A (BoNT-A) in children with spastic cerebral palsy (CP) have been introduced in clinical practice with the aim of reducing muscle tone, preventing muscle contractures and, ultimately, improving function. The aim of this study was to evaluate prospectively the MRI changes in the calf muscles, gastrocnemius (GN) and soleus (S) of two children with unilateral spastic CP (US-CP), prior and more than 1-year following BoNT-A injections. Two male patients with US-CP were injected at the level of the GN and S muscles. Patients underwent a first lower extremity MRI prior to the first BoNT-A injection at the level of GN and S muscles of the affected side. A second MRI was perfomed 34 and 22 months after the index procedure, respectively. Both legs were investigated together symmetrically, to allow a precise comparison between muscles and structures. The MRI protocol included three sequences: axial-T2 weighted tse, SPACE and axial-T1 weighted. We found that BoNT-A injected GN and S muscles had increased signal intensity on the MRI performed 22 and 34 months after index procedure, when compared to the contralateral, not placebo injected (NaCl) leg. To the best of our knowledge, no previous studies have investigated the changes induced in muscle structures in ambulatory children with US-CP managed by BoNT-A injections. Level of evidence: II.
在痉挛型脑瘫（CP）患儿中进行A型肉毒杆菌毒素（BoNT-A）肌肉注射已被引入临床实践，目的是降低肌张力、预防肌肉挛缩，并最终改善功能。本研究的目的是前瞻性评估两名单侧痉挛型脑瘫（US-CP）患儿在注射BoNT-A之前及注射后1年多小腿肌肉、腓肠肌（GN）和比目鱼肌（S）的MRI变化。两名US-CP男性患者在GN和S肌水平进行了注射。患者在患侧GN和S肌水平首次注射BoNT-A之前接受了第一次下肢MRI检查。分别在首次注射后34个月和22个月进行了第二次MRI检查。对双腿进行对称检查，以便对肌肉和结构进行精确比较。MRI检查方案包括三个序列：轴向T2加权快速自旋回波序列（tse）、SPACE序列和轴向T1加权序列。我们发现，与对侧未注射安慰剂（NaCl）的腿相比，在首次注射后22个月和34个月进行的MRI检查中，注射BoNT-A的GN和S肌信号强度增加。据我们所知，以前没有研究调查过接受BoNT-A注射治疗的能行走的US-CP儿童肌肉结构所发生的变化。证据级别：II级。
