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Comparison of Ultrasound-Guided Anterior and Posterior Approaches for Needle Insertion into the Tibialis Posterior in Hemiplegic Children with Spastic Cerebral Palsy

Authors
 Rha D-W  ;  Park ES  ;  Jung S  ;  Lee SC  ;  Suh M  ;  Choi HS 
Citation
 AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, Vol.93(10) : 841-848, 2014 
Journal Title
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION
ISSN
 0894-9115 
Issue Date
2014
MeSH
Analysis of Variance ; Anatomic Landmarks ; Botulinum Toxins, Type A/administration & dosage* ; Cerebral Palsy/diagnosis ; Cerebral Palsy/drug therapy* ; Child ; Child, Preschool ; Cohort Studies ; Female ; Follow-Up Studies ; Hemiplegia/diagnosis ; Hemiplegia/drug therapy* ; Humans ; Injections, Intramuscular ; Lower Extremity ; Male ; Muscle, Skeletal/diagnostic imaging ; Muscle, Skeletal/drug effects* ; Prospective Studies ; Tibia ; Treatment Outcome ; Ultrasonography, Doppler/methods
Keywords
Cerebral Palsy ; Ultrasonography ; Tibialis Posterior
Abstract
OBJECTIVE:
Although the tibialis posterior is a potentially difficult muscle to locate for botulinum toxin injection because of its deep location, needle insertion is usually performed using anatomic landmarks for guidance. Accordingly, the ultrasonographic anatomy of the lower leg was investigated in hemiplegic children with spastic cerebral palsy to improve the safety and the accuracy of needle placement into the tibialis posterior.
DESIGN:
Twenty-five subjects (2 yrs 2 mos to 5 yrs 11 mos; 12 boys, 13 girls; Gross Motor Function Classification System levels I-II) were recruited. B-mode, real-time ultrasonography was performed using a 5- to 12-MHz linear array transducer. During anterior and posterior approaches, safety window width (tibia to the neurovascular bundle) and depth (skin to the midpoint of the tibialis posterior) were measured at the upper third and at the midpoint of the tibia.
RESULTS:
For the anterior approach, the safety window width at the upper third of the tibia (mean [SD], 0.63 [0.12] cm, range, 0.44-0.93 cm) was significantly larger than that at the midpoint (0.38 [0.09] cm, range from 0.22 to 0.59 cm, P < 0.05) of the affected leg. However, for the posterior approach, the safety window width at the midpoint (0.74 [0.23] cm, range from 0.21 to 1.18 cm) was significantly larger than that at the upper third of the tibia (0.48 [0.23] cm, range from 0.10 to 0.97 cm, P < 0.05) on the affected leg.
CONCLUSIONS:
Ultrasonographic guidance is a useful, safe, and accurate tool for needle insertion into the tibialis posterior. Considering the safety window width, this study suggests needle placement at the upper third point of the tibia for the anterior approach and at the midpoint for the posterior approach.
Full Text
http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00002060-201410000-00001&LSLINK=80&D=ovft
DOI
10.1097/PHM.0000000000000170
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Rehabilitation Medicine (재활의학교실) > 1. Journal Papers
Yonsei Authors
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
Lee, Sang Chul(이상철) ORCID logo https://orcid.org/0000-0002-6241-7392
Jung, Soo Jin(정수진)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/99756
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