Kalça Adduktor Spastisitesi Olan Serebral Palsili Çocuklarda Botulinum Toksin-A Enjeksiyonu: Retrospektif Bir Çalışma
Botulinum Toxin-A Injection for Hip Adductor Spasticity in Children with Cerebral Palsy: A Retrospective Study
Received Date : 20 Mar 2021
Accepted Date : 27 Apr 2021
Available Online : 05 Apr 2021
Esra SARIGEÇİLİa, Melek SEZGİNb, Ünzüle HANBABAb, Didem DERİCİ YILDIRIMc,
Çetin OKUYAZd
aClinic of Pediatric Neurology, Adana City Training and Research Hospital, Adana, TURKEY
bDepartment of Physical Medicine and Rehabilitation, Mersin University Faculty of Medicine, Mersin, TURKEY
cDepartment of Biostatistics, Mersin University Faculty of Medicine, Mersin, TURKEY
dDepartment of Pediatric Neurology, Mersin University Faculty of Medicine, Mersin, TURKEY
Doi: 10.31609/jpmrs.2021-83191 - Makale Dili: EN
J PMR Sci. 2021;24(3):277-83
ÖZET
Amaç: Kalça adduktor kas spastisitesi olan serebral palsili (SP) çocuklarda
botulinum toksin-A’nın klinik ve radyolojik etkinliğini araştırmak.
SP intrauterin ya da erken infantil dönemde meydana gelen hareket ve postür
bozukluğuna yol açan santral sinir sisteminin nonprogressive bir hastalığıdır.
Gereç ve Yöntemler: Çalışma retrospektif olarak dizayn edildi.
Kalça adduktor kas spastisitesi olması sebebi ile 1 yıl süresince düzenli
BoNT-A enjeksiyonu uygulanan hastalar belirlendi. Klinik değerlendirme
için, dizler arası mesafe, modifiye Asworth skalası (MAS) ve kaba motor
fonksiyon sınıflandırma sistemi (KMFSS) hasta dosyalarından kaydedildi.
Radyolojik değerlendirme anterior-posterior pelvis radyografisinde asetabular
indeks (AI) ve kollo-diafizer açı (KDA) ölçümü yapılarak belirlendi.
Bulgular: Çalışmaya dâhil edilen 20 hastanın ortalama yaşları (erkek: 12,
kız: 8) 84,8±20,9 aydı (minimum-maksimum: 48-120 ay). 7 hasta diplejik,
7 hasta kuadriplejik ve 6 hasta mix tip SP’idi. Hastaların MAS ve KMFSS
skorları ilk enjeksiyondan sonraki 3. ve 12. ayda büyük ölçüde azaldı (sağ
p:0,007 sol p:0,005 ve p:0,002 idi). Benzer şekilde, 3. ve 12. ayda dizler
arası mesafe de giderek arttı (p<0,001). Ancak radyolojik değerlendirmede
AI ve KDA’da anlamlı düzelme görülmedi (p>0,05). Sonuç: Bu çalışmada,
kalça adduktor kas spastisitesi olan SP’li çocuklarda seri BoNT-A enjeksiyonunun
klinik bir düzelme sağladığı ve radyolojik olarak ise progressif
kalça dislokasyonunu önlediği gösterilmiştir.
Anahtar Kelimeler: Serebral palsi; kalça adduktor kas; spastisite; botulinum toksin-A; çocuklar
ABSTRACT
Objective: To assess clinical and radiological effectiveness
of botulinum neurotoxin-A (BoNT-A) injection in children with cerebral
palsy (CP) with spasticity in the hip adductor muscles. CP is a nonprogressive
central nervous system disease that occurs in the intrauterine or early
infantile period that leads to posture or motor dysfunction and activity and
movement-limitation. Material and Methods: This study was designed as
a retrospective. Patients who received BoNT-A injections consecutively during
one year due to spasticity in bilateral hip adductor muscles were identified.
For clinical evaluation, distance between the knees, Modified Ashworth
Scale (MAS), and Gross Motor Function Classification System (GMFCS)
scores were recorded from the patient files. Radiological evaluation was
performed by measuring acetabular index (AI) and collo-diaphyseal angle
(CDA) in the A/P pelvis radiographs available in the patient registry system.
Results: The mean age of 20 patients (boys:12, girls:8) included in the study
was 84.8±20.9 months (minimum-maximum: 48-120 months). Seven patients
had diplegic, 7 patients quadriplegic and 6 patients mixed type involvement.
The MAS and GMFCS scores of the patients were found to be
decreased significantly at the third and twelfth month after the first injection
compared to pre-treatment (right p:0.007, left p:0.005 and p:0.002, respectively).
Similarly, the distance between knees had increased statistically at
the third and twelfth month (p<0.001). However, in the radiological evaluation,
AI and CDA measurements were not statistically different after 3
months and 12 months compared to pre-treatment (p>0.05). Conclusion:
This study demonstrated that sequential BoNT-A injections may provide
clinical improvement and prevent radiological progression of the hip in children
with CP with bilateral hip adductor spasticity.
Keywords: Cerebral palsy; hip adductor muscle; spasticity; and botulinum Neurotoxin-A; children