Effects of open adductor tenotomy and adductor muscle botulinum toxin A injection on the hip instability in spastic type cerebral palsy

Yıl 2022, Cilt: 47 Sayı: 2, 511 - 518, 30.06.2022

Zeynel Mert Asfuroğlu Kemal Gökhan Günel Hakan Ömeroğlu

https://doi.org/10.17826/cumj.1002995

Öz

Purpose: We aimed to evaluate the clinical and radiographic outcomes of hip instability in children with spastic-type Cerebral Palsy (CP) who had undergone open Adductor Tenotomy (AT) or received Botulinum Toxin-A (BTX-A) injections to the hip adductor muscles .
Materials and Methods: Maximum Hip Abduction Angles (MHAA) with the knees and hips in extension were measured preoperatively and the latest clinical findings of all patients in the AT and BTX-A groups were recorded. Reimers’ Migration Percentage (RMP) was measured as the radiographic assessment in the AT group.
Results: There were 30 patients (mean age: 8.3 years) in the AT Group and 25 (mean age: 5.9 years) in the BTX-A Group whose clinical and radiographic data were available. The mean follow-up period in the AT Group was 29.6 months. In the AT Group, the mean MHAA before surgery and at the last assessment were 21.20 and 37.10 respectively. In the BTX-A Group, the mean MHAA before the injection and at the latest assessment were 25.30 and 34.20 respectively. The change in the mean MHAA in the AT Group was 16.20 and 8.80 in the BTX-A Group. In the AT Group, the preoperative RMP was 28.2% and the latest RMP was 22.2%.
Conclusion: AT and BTX-A injections significantly improved hip abduction angles. However, AT provided better clinical improvement and considerable radiographic correction in pediatric patients with spastic-type CP and hip instability.

Anahtar Kelimeler

cerebral palsy, botulinum toxin-A, adductor tenotomy

Spastik tip serebral palside açık addüktör tenotomi ve addüktör kas botulinum toksin-A enjeksiyonunun kalça eklemi instabilitesine etkileri

Öz

Amaç: Bu çalışmada Spastik tip serebral palsi (SP) tanılı hastalarda kalça instabilitesi nedeniyle açık addüktör tenotomi (AT) yapılanlar ile addüktör kaslara Botulinum toksin-A (BTX-A) enjeksiyonu yapılanların klinik ve radyolojik sonuçlarının değerlendirilmesi ve karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Hem AT grubunda hem de BTX-A grubunda kalça ve diz eklemleri tam ekstansiyonda iken maksimum kalça abdüksiyon açısı (MKAA) ölçüldü. MKAA’nın işlem öncesi değerleri ile son klinik muayenede elde edilen değerleri karşılaştırıldı. Bu ölçüme ek olarak AT grubunda kalça radyografileri üzerinde Reimers migrasyon yüzdesi (RMY) ölçüldü.
Bulgular: AT grubunda 30 (ortalama yaş: 8.3), BTX grubunda ise 25 (ortalama yaş: 5.9) hasta mevcuttu. Ortalama takip süresi AT grubunda 29.6 ay idi. AT grubunda ameliyat öncesi muayenede ve son muayenede ölçülen MKAA değerleri sırasıyla 21.20 ve 37.10 idi. BTX-A grubunda enjeksiyon öncesi muayenede ve son muayenede ölçülen MKAA değerleri sırasıyla 25.30 ve 34.20 idi. MKAA değerinin değişim miktarı ortalaması AT grubunda 16.20, BTX-A grubunda ise 8.80 idi. AT grubunda ameliyat öncesi RMY ortalaması %28.2, son muayene ortalaması ise %22.2 idi.
Sonuç: Hem AT grubunda hem de BTX-A grubunda kalça abdüksiyon açıları anlamlı düzeyde artmasına rağmen AT grubunda bu artış BTX-A grubuna kıyasla daha fazla olmaktadır. Ek olarak AT grubunda radyolojik olarak belirgin düzelme gözlenmektedir.

Anahtar Kelimeler

serebral palsi, botulinum toksin-A, addüktör tenotomi

Kaynakça

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