Study On The Injection Targets Of BTX-A In Spasm Of Cerebral Palsy Muscle In Children With Intramuscular Nerve Distribution Pattern Of The Adductor Hip And Posterior Calf Muscles

Objective: To investigate the intramuscular nerve distribution pattern in the hip adductors and posterior calf muscles of children and to precisely locate the injection site for botulinum toxin type A(BTX-A)as a treatment for hip adductor and posterior calf muscles spasticity in children with cerebral palsy.Method: Modified Sihler's whole mount nerve staining technique was employed to observe the distribution of intramuscular nerves in hip adductors(adductor longus,adductor brevis,gracilis,adductor magnus and pectineus)and posterior calf muscles(soleus,gastrocnemius,Flexor halluccis longus,Flexor digitorum longus and Tibialis posterior)of children and to further locate zones where terminal nerves are concentrated.Results: The terminal nerves of the adductor longus appeared in a longitudinal distribution band parallel to the line between the upper 1/3 point of the lateral boundary and the center of the medial boundary.In adductor brevis,the terminal nerves showed a sheet-like distribution with a nerve dense area located in the middle of the muscle belly that extends from the upper-inner region to the lower-outer region.Gracilis showed a dense area of terminal nerves in the middle of the muscle belly,closer to the posterior boundary.In adductor magnus,the dense area of terminal nerves showed a sheet-like distribution in the middle and lower region of the muscle belly.The dense area of terminal nerves in the pectineus was located in the middle of the muscle belly.The intramuscular nerve branches of soleus muscle were shaped like a "broomstick",and the concentrated area of terminal nerve was mainly located in the lower half of the muscle abdomen.The intramuscular terminal nerve concentration areas of the medial head of gastrocnemius and the lateral head of gastrocnemiusthe were located in the lower 1/3 of the muscle abdomen.The terminal nerve area of Flexor halluccis longus are similar to "rectangles" that lie mainly in the lower part of the muscular abdomen.The intramuscular terminal nerve density area of flexor digitorum longus was in the shape of "band",which was mainly located in the middle part of muscle abdomen.The intramuscular terminal nerves of the posterior tibial are concentrated mainly in the middle of the muscle abdomen.Conclusion:(1).This study systematically demonstrated the intramuscular nerve distribution patterns of the adductor hip and posterior calf muscles in children.(2).The scope of intramuscular terminal nerve and its intensive area of the adductor hip and posterior calf muscles in children is clearly displayed,providing the best injection target area for BTX-A anti-spasticity treatment in children with cerebral palsy.