Calderon-Gonzalez R, Calderon-Sepulveda R, Rincon-Reyes M, Garcia-Ramirez J, Mino-Arango E
Department of Pediatric Neurology, Children and Adolescents Neurological Center, Monterrey, Mexico.
Pediatr Neurol. 1994 Jun;10(4):284-8. doi: 10.1016/0887-8994(94)90123-6.
The efficacy of local injection of botulinum toxin A in selected skeletal muscles to relieve muscle hypertonia and muscle contracture, and increase range of motion in children with cerebral palsy was studied in an open ABA (baseline-treatment-posttreatment phase) type of study. The first 6 months were the baseline phase, the day of injection the treatment phase, and the next 6 months the posttreatment phase. The patients acted as their own controls. Fifteen children with cerebral palsy (mean age: 6 years, 8 months) were included in the study. All had limb deformities associated with non-fixed joint contractures that had not responded to physical therapy. Clinical assessment of passive and active muscle tone was performed using a modified Ashworth scale. The range of motion to passive movement was measured with a manual goniometer. Botulinum toxin was injected directly into the muscle at several sites. The postinjection scores of muscle hypertonia were significantly lower (P < .01) and the range-of-motion values demonstrated a significant increase (P < .001). Functional improvement was measured by decreased scissoring on standing in all 6 children with adductor muscles injected; all 6 children with knee flexor muscles injected were able to straighten the knees. The 3 children with injected gastrocnemius muscles were able to achieve heel-strike while bare-footed. The study provides evidence that the intramuscular injection of botulinum toxin A in selected skeletal muscles decreases muscle tone and contractures, and increases range of motion and motor function.
在一项开放的ABA（基线-治疗-治疗后阶段）类型的研究中，对局部注射A型肉毒杆菌毒素于特定骨骼肌以缓解脑瘫患儿的肌肉张力亢进和肌肉挛缩，并增加关节活动范围的疗效进行了研究。前6个月为基线期，注射当天为治疗期，接下来的6个月为治疗后期。患者自身作为对照。15名脑瘫患儿（平均年龄：6岁8个月）纳入研究。所有患儿均有与非固定性关节挛缩相关的肢体畸形，且对物理治疗无反应。使用改良Ashworth量表对被动和主动肌张力进行临床评估。用手动角度计测量被动运动的关节活动范围。将肉毒杆菌毒素直接注射到肌肉的几个部位。注射后肌肉张力亢进评分显著降低（P <.01），关节活动范围值显著增加（P <.001）。功能改善通过以下指标衡量：所有6名注射内收肌的患儿站立时剪刀步态减轻；所有6名注射屈膝肌的患儿能够伸直膝盖。3名注射腓肠肌的患儿能够在赤足时实现足跟落地。该研究提供了证据，表明在特定骨骼肌内注射A型肉毒杆菌毒素可降低肌张力和挛缩，并增加关节活动范围和运动功能。
