A型肉毒杆菌毒素用于下肢延长和畸形矫正：一项系统评价和荟萃分析。

Botulinum toxin type A for lower limb lengthening and deformity correction: A systematic review and meta-analysis.

作者信息

Ghaddaf Abdullah A, Alsharef Jawaher F, Alomari Mohammed S, Al Qurashi Abdullah A, Abdulhamid Ahmed S, Alshehri Mohammed S, Alosaimi Majed

机构信息

College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.

College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Surgery/Orthopedic Section, King Abdulaziz Medical City, Jeddah, Saudi Arabia.

出版信息

J Orthop Sci. 2023 Jul;28(4):806-813. doi: 10.1016/j.jos.2022.04.011. Epub 2022 May 26.

DOI:10.1016/j.jos.2022.04.011

PMID:35643907

Abstract

BACKGROUND

Botulinum toxin type A (BTX-A) is the most popular therapeutic agent for muscle relaxation and pain control. Lately, BTX-A injection received great interest as a part of multimodal pain management for lower limb lengthening and deformity correction. This systematic review aimed to determine the role of BTX-A injection in pain management for during lower limb lengthening and/or deformity correction.

METHODS

We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the BTX-A injection to placebo for individuals undergoing lower limb lengthening and/or deformity correction. We sought to evaluate the following outcomes: pain on visual analogue scale (VAS), range of motion parameters, average opioid consumption, and adverse events. The standardized mean difference (SMD) was used to represent continuous outcomes while risk ratio (RR) was used to represent dichotomous outcomes.

RESULTS

A total of 4 RCTs that enrolled 257 participants (337 limbs) deemed eligible. Adjuvant BTX-A injection showed a significant reduction in post-operative pain compared to placebo (SMD = -0.28, 95% CI -0.53 to -0.04). No difference was found between BTX-A injection and placebo in terms of range of motion parameters, average opioid consumption, or adverse events after surgical limb lengthening and/or deformity correction (RR = 0.77, 95% CI -0.58 to 1.03).

CONCLUSIONS

Adjuvant BTX-A injection conferred a discernible reduction in post-operative pain during surgical limb lengthening and/or deformity without increasing the risk of adverse events.

PROSPERO REGISTRATION NUMBER

CRD42021271580.

摘要

背景

A型肉毒杆菌毒素（BTX-A）是用于肌肉松弛和疼痛控制的最常用治疗药物。最近，BTX-A注射作为下肢延长和畸形矫正多模式疼痛管理的一部分受到了广泛关注。本系统评价旨在确定BTX-A注射在下肢延长和/或畸形矫正疼痛管理中的作用。

方法

我们检索了Medline、Embase和CENTRAL。我们纳入了将BTX-A注射与安慰剂进行比较的随机对照试验（RCT），这些试验的对象是接受下肢延长和/或畸形矫正的个体。我们试图评估以下结果：视觉模拟量表（VAS）上的疼痛、运动范围参数、平均阿片类药物消耗量和不良事件。标准化均数差（SMD）用于表示连续结果，而风险比（RR）用于表示二分结果。

结果

共有4项RCT纳入了257名参与者（337条肢体），认为符合条件。与安慰剂相比，辅助性BTX-A注射显示术后疼痛显著减轻（SMD = -0.28，95%CI -0.53至-0.04）。在手术肢体延长和/或畸形矫正后，BTX-A注射与安慰剂在运动范围参数、平均阿片类药物消耗量或不良事件方面没有差异（RR = 0.77，95%CI -0.58至1.03）。