The Influence of Botulinum Toxin A Injections into the Calf Muscles on Genu Recurvatum in Children With Cerebral Palsy
The Influence of Botulinum Toxin A Injections into the Calf Muscles on Genu Recurvatum in Children With Cerebral Palsy
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DOI：
10.1007/s11999-013-2897-7
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发表时间：
2013-07-01
影响因子：
4.2
通讯作者：
Dreher, Thomas
中科院分区：
文献类型：
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作者：
Klotz, Matthias C. M.;Wolf, Sebastian I.;Dreher, Thomas
对于脑性瘫痪(CP)，马蹄畸形可导致膝反弯。A型肉毒杆菌毒素(BTA)小腿肌肉注射是治疗动力性马蹄内翻足的有效方法，本研究旨在探讨小腿肌肉注射A型肉毒杆菌毒素减少马蹄内翻足是否能减少马蹄内翻足患儿膝反曲的发生率。在干预前、干预后6周和18周进行三维步态分析，并按标准化方案进行临床检查。基础统计分析(POWER分析，ANOVA)比较治疗前和注射BTA后6周和18周的膝反屈情况。在站立期，踝关节最大背屈从注射前的-3.0A°A+/-A 14.3A度显著增加到6周后的6.2A°A+/-A 14.2A度。尽管如此，根据现有的数据，在6周或18周的治疗中，站立状态下的下垂数量并没有改善。BTA注射后18周至基础状态时膝关节过度伸展6.2a度有显著改善，但大部分患者仍有膝反屈，尽管注射BTA后踝关节背屈有改善，但在注射后6周或18周时，膝反屈仍未有相应的改善。由于膝关节过度伸展在大多数患者中仍然存在，因此应考虑其他导致膝反弯的因素。此外，肉毒杆菌毒素引起的腓肠肌无力可能解释了为什么直立步态没有显著减少。有关证据级别的完整描述，请参阅作者指南。
With cerebral palsy (CP), an equinus deformity may lead to genu recurvatum. Botulinum toxin A (BtA) injection into the calf muscles is a well-accepted treatment for dynamic equinus deformity.The purpose of this study was to determine whether BtA injections into the calf muscles to decrease equinus would decrease coexisting genu recurvatum in children with diplegic CP.In a retrospective study, 13 children (mean age, 5 years) with spastic diplegic CP showing equinus and coexisting primary genu recurvatum, who were treated with BtA injections into the calf muscles, were included. Evaluations were done before and 6 and 18 weeks after intervention using three-dimensional gait analysis and clinical examinations according to a standardized protocol. Basic statistical analyses (power analysis, ANOVA) were performed to compare genu recurvatum before treatment and at 6 and 18 weeks after injection with BtA.During stance phase, maximum ankle dorsiflexion was increased substantially from -3.0A degrees A A +/- A 14.3A degrees before to 6.2A degrees A A +/- A 14.2A degrees 6 weeks after the injections. Despite this, with the numbers available, the amount of recurvatum in stance did not improve with treatment at either 6 or 18 weeks. There was significant improvement of knee hyperextension during stance phase of 6.2A degrees between baseline and 18 weeks after BtA injection, but a genu recurvatum was still present in most patients.Despite improvement of ankle dorsiflexion after injection with BtA, genu recurvatum did not show relevant improvement at 6 or 18 weeks after injection with the numbers available. Because knee hyperextension remained in most patients, other factors leading to genu recurvatum should be taken into consideration. In addition, a botulinum toxin-induced weakness of the gastrocnemius may explain why recurvatum gait was not significantly reduced.Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.