Murgia Massimiliano, de Sire Alessandro, Ruiu Pierangela, Agostini Francesco, Bai Arianna Valeria, Pintabona Giovanni, Paolucci Teresa, Bemporad Jonathan, Paoloni Marco, Bernetti Andrea
Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy.
Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy.
J Back Musculoskelet Rehabil. 2023;36(5):1193-1201. doi: 10.3233/BMR-220381.
Cerebral palsy (CP) is the most common physical disability in childhood. It is a heterogeneous condition in terms of etiology, motor type and severity of impairments. Clinical impairments, such as increased muscle tone (spasticity), muscle weakness and joint stiffness contribute to the abnormal development of functional activities, including gait.
The objective of this study was to investigate the popliteal angle to hamstring length after ultrasound guided Incobotulinum toxin A injections for spasticity in CP patients.
In this proof-of-concept study, we included outpatients with CP and crouch gait correlated to hamstrings spasticity referred to the Pediatric Rehabilitation outpatient clinic of Umberto I University Hospital, Sapienza University of Rome, in the period between February and October 2018.
Modified Ashworth Scale (MAS) of hamstring muscles, Popliteal Angle and Modified Popliteal Angle, Passive Knee Extension and 10 Meter Walk Test (10MWT) were assessed at baseline (T0) and three weeks after ultrasound guided injection (T1) of Incobotulinum Toxin A (dose weight and site dependent).
Thirteen patients (5 male and 8 female), mean aged 9.91 ± 3.59, were included. The clinical evaluation at T0 showed hamstring muscles spasticity, with MAS of 2.4 ± 0.6, popliteal angle -51.7∘± 11.0∘, modified popliteal angle of -39.5∘± 11.0∘, passive knee extension of -14.0∘± 8.7∘ and 10MWT of 14.3 ± 4.6 seconds. At T1, hamstring muscles MAS mean value was 1.7 ± 0.6 (p< 0.01), popliteal angle 41.3∘± 7.0∘ (p< 0.001), modified popliteal angle -32.9∘± 10.4∘ (p< 0.001), passive knee extension -4.0∘± 4.2∘ (p< 0.05) and 10MWT 12.6 ± 4.8 seconds (p< 0.05). None of the treated patients reported any adverse event related to Incobotulinum Toxin A injection.
Incobotulinum toxin A treatment has been proven to be safe and effective for hamstring muscles spasticity management in CP patients. Further studies with larger samples and longer follow-up are warranted to assess the efficacy of this treatment on the popliteal angle.
脑性瘫痪（CP）是儿童期最常见的身体残疾。就病因、运动类型和损伤严重程度而言，它是一种异质性疾病。临床损伤，如肌张力增加（痉挛）、肌肉无力和关节僵硬，会导致包括步态在内的功能活动异常发育。
本研究的目的是调查超声引导下注射A型肉毒杆菌毒素治疗CP患者痉挛后腘角与腘绳肌长度的关系。
在这项概念验证研究中，我们纳入了2018年2月至10月期间转诊至罗马第一大学医院（Sapienza大学）儿科康复门诊的CP门诊患者，其蹲伏步态与腘绳肌痉挛相关。
在基线（T0）和超声引导下注射（T1）依可肉毒杆菌毒素A（剂量依体重和部位而定）三周后，评估腘绳肌改良Ashworth量表（MAS）、腘角和改良腘角、被动膝关节伸展和10米步行试验（10MWT）。
纳入13例患者（5例男性，8例女性），平均年龄9.91±3.59岁。T0时的临床评估显示腘绳肌痉挛，MAS为2.4±0.6，腘角-51.7°±11.0°，改良腘角-39.5°±11.0°，被动膝关节伸展-14.0°±8.7°，10MWT为14.3±4.6秒。在T1时，腘绳肌MAS平均值为1.7±0.6（p<0.01），腘角41.3°±7.0°（p<0.001），改良腘角-32.9°±10.4°（p<0.001），被动膝关节伸展-4.0°±4.2°（p<0.05），10MWT为12.6±4.8秒（p<0.05）。所有接受治疗的患者均未报告任何与注射依可肉毒杆菌毒素A相关的不良事件。
已证明依可肉毒杆菌毒素A治疗对CP患者的腘绳肌痉挛管理是安全有效的。有必要进行更大样本量和更长随访时间的进一步研究，以评估该治疗对腘角的疗效。
