Purpose: The purpose of this study is to evaluate the effect of Botulinum toxin A (BTX-A) on the subluxation of the hips in patients with spastic CP.
Methods: We report on 12 cerebral palsy patients with 15 treated hips. Ten patients were quadriplegic and two were diplegic. The initial radiographic evaluation was taken at an age between 5 years and 7 years and 3 months (median: 5 y and 6 months). Reimer’s migration percentage was determined on a standard a.p. X-ray one to fourteen (median 2.63) months before and two to nine months (median 5,68) after botox infiltration. The dose of therapeutic Botox per muscle was selected based on muscle size and the desired treatment effect. Post botox abduction was given by an abduction brace or long leg casts with an abduction bar. Intensive stretchings of adductor and psoas musculature was started. The orthosis was worn during 23 hours a day during 6 weeks. After this period continuous abduction was built in wheelchair and nightorthosis. To exclude the effect of outliners in a limited test group, non-parametric statistical analyses were performed. The data analysis of the study were split up into three parts: 1. analysis of the total group (N=15), 2. analysis of the subgroup with two follow-up times (N=11), 3. analysis of the subgroup receiving two BTX-A treatments (N=6). For each group, the median and interquartile range (IQR) for the 4 parameters were calculated at different evaluation times. A Wilcoxon signed rank test was performed determining statistical significant differences between pre and post BTX-A conditions. The critical P-value was defined as 0.05. All statistical procedures were performed with the SAS system.