| ObjectiveTo investigate the long-term clinical efficacy, the improvement of motor function and adverse reaction of ultrasound-guided Botulinum toxin A injection for gastrocnemius spasticity for infantile cerebral palsy.MethodsEighty children with cerebral palsy in Children’s Rehabilitation Department of the third affiliated hospital of Zheng Zhou University from Jan 2014 to Dec 2014 cerebral palsy were included in this study, and gastrocnemius muscle is the target muscle for BTX-A injection. The patients were randomly divided into routine treatment group and BTX-A injection group, and each group has 40 cases. Among the routine treatment group, 32 cases of male, 8 cases of female, mean age 20.00±5.59 months, 21 cases of spastic diplegia, 8 cases of spastic hemiplegia,11 cases of spastic quadriplegia; Among the BTX-A injection group, 28 cases of male, 12 cases offemale, mean age 19.95±5.29 months, 21 cases of spastic diplegia, 9 cases of spastic hemiplegia, 10 cases of spastic quadriplegia. Routine treatment group were treated with 4 courses of physical therapy, physical factors therapy and other common rehabilitation technology, BTX-A injection group were treated with ultrasound guided BTX-A injection plus the same treatment received by routine treatment group. Before and at the 1st, 2nd, 3rd, 6th, 12 th month post-injection, modified Tardieu scale(MTS)was employed to evaluate gastrocnemius spasticity, surface electromyography(s EMG)was employed to evaluate muscle tension, The gross motor function measure-88( GMFM-88) was used o assess functional improvement of motor function,.Inclusion criteria:(1) Conform to the diagnostic criteria of cerebral palsy in the ninth national conference on rehabilitation of children with cerebral palsy, and should be spastic cerebral palsy;(2) Ages ranged from 9 to 36 months;(3) Gross motor function classification II ~ IV;(4) The ankle joint angle R2-R1 of MTS is more than or equal to 10 °;(5) Without injection of BTX-A in the past 6 months;(6)Gastrocnemius muscle spasm and the children have not received surgical treatment;(7) The family agreed to receive BTX-A injection and signed the informed consent.Exclusion criteria:(1) Allergy, severe hepatic and renal dysfunction;(2)Existence of neuromuscular junction disorders;(3) Infection in injection site or in other parts of the body;(4) Use drugs that increase neuromuscular transmission disorder within the past week;(5) Fixed joint, severe contracture of the target muscles.ResultsBefore the treatment, there was no significant difference in the grading scores(x)of MTS, between the routine treatment group and BTX-A injection group,(t=-0.980,P=0.327);The grading scores(x) of MTS in the two groups reduced with the prolonging of treatment(F=52.509, P = 0.000). The difference of grading scores(x) of MTS in two groups was statistically significant(F=6.607, P = 0.012).The grading score(x) of MTS is interactional between different groups and before and after treatment(F=15.708, P = 0.000).Before the treatment, there was no significant difference in the joint angles(R1)of MTS between the routine treatment group and the BTX-A injection group(P=0.192,t=-1.319); The joint angle(R1) of MTS in the two groups reduced with the prolonging of treatment(F=89.079,P=0.000). The difference of joint angle(R1) of MTS in two groups was statistically significant(F=6.476,P=0.013). The joint angle(R1) of MTS is interactional between different groups and before and after treatment(F=25.122,P=0.000).Before the treatment,there was no significant difference in the joint angles(R2)of MTS between the routine treatment group and the BTX-A injection group(P=0.233,t=-1.204); The joint angle(R2) of MTS in the two groups reduced with the treatment prolonged(F=220.680,P=0.000). The difference of joint angles(R2) of MTS in two groups was statistically significant(F=5.486,P=0.022). The joint angle(R2) of MTS is interactional between different groups and before and after treatment(F=51.481,P=0.000).Before the treatment, there was no significant difference in the i EMG of s EMG passive state between the routine treatment group and the BTX-A injection group(P=0.470,t=0.726); The i EMG of s EMG passive state in two groups reduced with with the treatment prolonged(F=300.291,P=0.000). The difference of the i EMG of s EMG passive state in the two groups was statistically significant(F=8.142,P=0.006).The i EMG of s EMG passive state is interactional between different groups and before and after treatment(F=21.374,P=0.000).Before the treatment, there was no significant difference in the GMFM scores between the routine treatment group and the BTX-A injection group(P=0.908,t=0.116); GMFM scores in the two groups reduced reduced with the treatment prolonged(F=304.752, P=0.000). The difference of GMFM scores in the two groups was statistically significant(F=8.274, P=0.007). GMFM is interactional between different groups and before and after treatment(F=30.890,P=0.000).The adverse reactions of BTX-A injection: 33 cases of children had transient strength decline, and recovered 2 ~ 4 weeks after injection, and only 1 case recovered1 month after injection; 1 case had red rash on limbs 18 h after BTX-A injection,without other symptoms, it might be skin allergy.Conclusions1.Ultrasound guided BTX-A injection combination rehabilitation can reduce gastrocnemius spasticity of infantile cerebral palsy, which has long-term effect, and it can promote the development of gross motor function of children with cerebral palsy,reduce or prevent abnormal posture, avoid joint deformity and delay the operative time.2. Ultrasound guided BTX-A injection is safety for infantile with cerebral palsy and the adverse reactions are rare.3.The location of BTX-A injection guided by ultrasound is accurate, it allow us to monitor the injection process, avoid wrong injection and damages to the surrounding muscles, glands and nerves. |
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