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Comparison of botulinum toxin type A injection and soft-tissue surgery to treat hip subluxation in children with cerebral palsy.

Authors
 Eun Joo Yang  ;  Dong-wook Rha  ;  Hyun Woo Kim  ;  Eun Sook Park 
Citation
 ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION, Vol.89(11) : 2108-2113, 2008 
Journal Title
 ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION 
ISSN
 0003-9993 
Issue Date
2008
MeSH
Botulinum Toxins, Type A/therapeutic use* ; Cerebral Palsy/complications ; Cerebral Palsy/rehabilitation* ; Child, Preschool ; Female ; Hip Dislocation/prevention & control* ; Hip Joint* ; Humans ; Infant ; Joint Instability/diagnostic imaging ; Joint Instability/drug therapy* ; Joint Instability/surgery* ; Male ; Muscle Spasticity ; Muscle, Skeletal/surgery ; Neuromuscular Agents/therapeutic use* ; Radiography ; Retrospective Studies
Keywords
Botulinum toxin type A ; Cerebral palsy ; Rehabilitation
Abstract
OBJECTIVE: To compare the effects of botulinum toxin type A (BTX-A) injection into the hip adductor muscles on hip displacement with soft-tissue surgery and assess the factors related to a favorable outcome after intervention in children with bilateral spastic cerebral palsy (CP). DESIGN: Retrospective chart review with regard to radiographic findings. SETTING: University hospital. PARTICIPANTS: Children with CP (N=194). INTERVENTIONS: BTX-A injection and soft-tissue surgery into the hip adductor muscles. MAIN OUTCOME MEASURE: The Reimers hip migration percentage (MP). RESULTS: Sixty-nine children did not receive any therapeutic intervention for hip displacement, whereas 60 children underwent soft-tissue surgery and 65 children took BTX-A injection for the spasticity of their hip muscles. MP was measured on each radiograph of the pelvis. The annual change of MP was improved in both the soft-tissue surgery and BTX-A groups, whereas it worsened in the nonintervention group. The annual improvement of MP in the BTX-A group did not differ significantly from that of the soft-tissue surgery group. The improvement in hip displacement after therapeutic intervention was greater in young children and high-functioning groups compared with older children and low-functioning groups. Hip displacement was progressive in the severely hip subluxated group despite therapeutic intervention. CONCLUSIONS: Comparable effects of BTX-A injection to soft-tissue surgery in our study suggest that BTX-A injection, if timely reinjected, may replace soft-tissue surgery as a prophylactic procedure against progressive hip subluxation or dislocation in children. Age at intervention, functional level, and initial MP before therapeutic intervention were the factors affecting the outcomes.
Full Text
http://www.sciencedirect.com/science/article/pii/S0003999308005534
DOI
10.1016/j.apmr.2008.04.019
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Rehabilitation Medicine (재활의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyun Woo(김현우) ORCID logo https://orcid.org/0000-0001-8576-1877
Rha, Dong Wook(나동욱) ORCID logo https://orcid.org/0000-0002-7153-4937
Park, Eun Sook(박은숙) ORCID logo https://orcid.org/0000-0002-9144-3063
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/107745
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