肉毒杆菌毒素治疗脑瘫患儿上肢后功能获益的证据有限：系统评价与荟萃分析

Limited Evidence of Functional Benefit After Upper Limb Botulinum Toxin Treatment in Children With Cerebral Palsy: Systematic Review and Meta-analysis.

作者信息

Gresits Orsolya Zsuzsanna, Vezér Mátyás, Engh Marie Anne, Szabó László, Molnár Zsolt, Hegyi Péter, Terebessy Tamás

机构信息

From the Centre for Translational Medicine, Semmelweis University, Budapest, Hungary (OZG, MV, MAE, LS, ZM, PH, TT); Department of Orthopaedics, Semmelweis University, Budapest, Hungary (OZG, MV, TT); Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary (ZM); Department of Anesthesiology and Intensive Therapy, Poznan University for Medical Sciences, Poznan, Poland (ZM); and Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary (PH).

出版信息

Am J Phys Med Rehabil. 2025 Feb 1;104(2):108-116. doi: 10.1097/PHM.0000000000002533. Epub 2024 Dec 19.

DOI:10.1097/PHM.0000000000002533

PMID:39789713

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11708987/

Abstract

OBJECTIVES

This systematic review and meta-analysis of randomized controlled trials aimed to summarize the reported functional effects of upper limb botulinum toxin treatment in children with spastic cerebral palsy.

DESIGN

Six databases were searched in October 2022. Two independent authors screened and extracted data on upper limb function, body function, life quality, muscle tone, spasticity, goals, pain, adverse events, and client satisfaction. A random effect model meta-analysis was performed, and RoB 2 and GRADE pro tools were used.

RESULTS

A total of 4862 publications were screened, 14 trials (621 patients) included. Pooled analyses confirm a decrease in muscle tone: mean difference Ashworth scale wrist -0.85 (95% confidence interval = -1.42 to -0.27). No significant functional gain was established: Melbourne Assessment mean difference 3.13 (95% confidence interval = -3.13 to 9.3), and Assisting Hand Assessment mean difference 3.84 (95% confidence interval = -1.86 to 9.54). Botulinum toxin groups had better goal achievement: Goal Attainment Scaling T scores mean difference 9.55 (95% confidence interval = 6.05 to 13.04) and better client satisfaction: improvement had an odds ratio of 8.44 (95% confidence interval = 1.34 to 53.08).

CONCLUSIONS

Results suggest that upper limb botulinum toxin treatment is effective to decrease muscle tone, but functional benefits are not clearly established. The discrepancy between subjective and objective results requires further investigation.

摘要

目的

本随机对照试验的系统评价和荟萃分析旨在总结上肢肉毒毒素治疗痉挛型脑瘫患儿所报告的功能效果。

设计

于2022年10月检索了六个数据库。两位独立作者筛选并提取了有关上肢功能、身体功能、生活质量、肌张力、痉挛、目标、疼痛、不良事件和患者满意度的数据。进行了随机效应模型荟萃分析，并使用了RoB 2和GRADE pro工具。

结果

共筛选了4862篇出版物，纳入14项试验（621例患者）。汇总分析证实肌张力降低：Ashworth量表腕部平均差异为-0.85（95%置信区间=-1.42至-0.27）。未确定有显著的功能改善：墨尔本评估平均差异为3.13（95%置信区间=-3.13至9.3），辅助手评估平均差异为3.84（95%置信区间=-1.86至9.54）。肉毒毒素组有更好的目标达成情况：目标达成量表T分数平均差异为9.55（95%置信区间=6.05至13.04），且患者满意度更高：改善的优势比为8.44（95%置信区间=1.34至53.08）。