title: Comparison of botulinum toxin type A injection and soft-tissue surgery to treat hip subluxation in children with cerebral palsy.
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).
  
  
  METHODS
  Retrospective chart review with regard to radiographic findings.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Children with CP (N=194).
  
  
  METHODS
  BTX-A injection and soft-tissue surgery into the hip adductor muscles.
  
  
  METHODS
  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.
authors.affiliation: Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Eun Joo
authors.initials: EJ
authors.lastname: Yang
authors.forename: Dong-Wook
authors.initials: DW
authors.lastname: Rha
authors.forename: Hyun Woo
authors.initials: HW
authors.lastname: Kim
authors.forename: Eun Sook
authors.initials: ES
authors.lastname: Park
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications / Q000534:rehabilitation*; D002675:Child, Preschool; D005260:Female; D006617:Hip Dislocation / Q000517:prevention & control*; D006621:Hip Joint; D006801:Humans; D007223:Infant; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D009128:Muscle Spasticity; D018482:Muscle, Skeletal / Q000601:surgery; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011859:Radiography; D012189:Retrospective Studies
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A