Calf muscle growth after Onabotulinum toxin A injection in children with
spastic cerebral palsy: a prospective study

doi:10.3760/cma.j.issn.1007-1245.2022.08.008

Abstract

Abstract: Objective　To investigate the muscle growth of gastrocnemius, soleus, and tibialis anterior after Onabotulinum toxin A injection and intensive physiotherapy program in children with cerebral palsy. Methods　From December 2014 to March 2016, 24 children with spastic cerebral palsy aged 2-7 years from Guangzhou Women and Children's Medical Center participated in this prospective study, including 14 boys and 10 girls. Their lower limbs were divided into a diplegia cerebral palsy group (DCP group, 28 lower limbs in 14 children with diplegia cerebral palsy), an affected side of hemiplegia cerebral palsy group (aHCP group, 10 affected lower limbs in 10 children with hemiplegia cerebral palsy), and a control group (uHCP group, 10 unaffected lower limbs in 10 children with hemiplegia cerebral palsy). Interventions included Onabotulinum toxin A injection and intensive physiotherapy program. Assessments were applied at baseline and 12 and 24 weeks after Onabotulinum toxin A injection and physiotherapy. Ultrasound measurement parameters were muscle thickness, fascicle length, and growth rate. Clinical measurement parameters were gross motor function measure, modified Ashworth scale, and modified Tardieu scale. Independent sample t test or one-way ANOVA was used for the measurement data conforming to normal distribution, rank sum test was used for the measurement data conforming to abnormal distribution, Chi-square test was used for the count data, and the Pearson correlation analysis was used. Results　The gross motor function, spasticity, and most muscle architecture were improved in the three groups after Onabotulinum toxin A injection and intensive physiotherapy (all P<0.05). The average growth rates of gastrocnemius muscle thickness and fascicle length of the affected legs were 6.24% and 7.99% after 24 weeks. For the internal/lateral gastrocnemius muscle thickness and fascicle length and soleus muscle thickness in the DCP group, the lateral gastrocnemius fascicle length in the aHCP group, and the internal gastrocnemius fascicle length in the uHCP group, the growth rates from baseline to 12 weeks after intervention were better than those from 12 weeks to 24 weeks after intervention (all P<0.05); the soleus muscle growth rate of the DCP group from baseline to 24 weeks after intervention was better than those of the aHCP group and uHCP group (both P<0.05); the growth rates of soleus fascicle length in the DCP group and uHCP group from 12 weeks to 24 weeks after intervention were better than that in the aHCP group (both P<0.05). Conclusion　Children aged 2-7 years with spastic cerebral palsy might undergo longitudinal and cross-sectional growth in calf muscles after single Onabotulinum toxin A injection and physiotherapy.

Key words: Cerebral palsy, Muscle architecture, Spasticity, Disuse, Calf, Ultrasound imaging, Onabotulinum toxin A

摘要： 目的　研究A型肉毒毒素对脑瘫患儿腓肠肌、比目鱼肌和胫骨前肌生长发育的影响。方法　本项目为前瞻性研究，纳入2014年12月至2016年3月在广州市妇女儿童医疗中心的24例年龄2～7岁的痉挛型脑瘫患儿（14例男孩、10例女孩），分为痉挛型双瘫组（DCP组，14例痉挛型双瘫患儿的28个患侧下肢）、偏瘫患侧组（aHCP组，10例偏瘫患儿的10个患侧下肢）、对照组（uHCP组，10例偏瘫患儿的10个健侧下肢）。在基线期、A型肉毒毒素注射结合物理治疗后12周与24周分别进行评估，超声检测肌肉厚度、肌束长度并计算肌肉生长速率，临床功能测试包括粗大运动功能测试、改良Ashworth量表和改良Tardieu量表。计量资料符合正态分布，采用独立样本t检验或单因素方差分析；计量资料不符合正态分布，采用秩和检验；计数资料采用卡方检验；相关性分析采用Pearson相关性分析。结果　A型肉毒毒素注射结合物理治疗后，3组下肢的粗大运动功能、痉挛程度和肌肉结构均得到改善（均P<0.05）。治疗后24周，患肢内侧腓肠肌的平均生长率分别是肌厚度6.24%、肌束长度7.99%；DCP组的内/外侧腓肠肌肌厚度、肌束长度与比目鱼肌肌厚度，aHCP组的外侧腓肠肌肌束长度，uHCP组的内侧腓肠肌肌束长度，在基线期至干预后12周的生长率优于干预后12周至24周的（均P<0.05）；在基线期至干预后24周，DCP组的比目鱼肌生长率优于aHCP组和uHCP组（均P<0.05）；在干预后12周至24周，DCP组、uHCP组的比目鱼肌肌束长度的生长率优于aHCP组（均P<0.05）。结论　单次A型肉毒毒素注射结合物理治疗后，2～7岁痉挛型脑瘫患儿的胫骨前肌、内/外侧腓肠肌、比目鱼肌都表现出肌肉厚度、肌束长度增加的肌肉结构改善现象。

关键词: 脑瘫, 肌肉结构, 痉挛, 废用, 小腿, 超声成像技术, A型肉毒毒素

He Lu, Li Jinling, Yang Xubo, Zheng Yun, Xu Kaishou. Calf muscle growth after Onabotulinum toxin A injection in children with spastic cerebral palsy: a prospective study[J]. International Medicine and Health Guidance News, 2022, 28(8): 1070-1076.

何璐, 李金玲, 杨旭博, 郑韵, 徐开寿. A型肉毒毒素注射对痉挛型脑瘫患儿小腿肌肉生长发育影响的前瞻性研究[J]. 国际医药卫生导报, 2022, 28(8): 1070-1076.

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Calf muscle growth after Onabotulinum toxin A injection in children with spastic cerebral palsy: a prospective study

A型肉毒毒素注射对痉挛型脑瘫患儿小腿肌肉生长发育影响的前瞻性研究

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