Skip to main content

Advertisement

SpringerLink
Log in

Botulinumtoxin-Therapie in der Orthopädie

Botulinum toxin therapy in orthopaedics

  • Weiterbildung•Zertifizierte Fortbildung
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Die Behandlung funktioneller Störungen des Bewegungsapparates mit Botulinumtoxin A stellt eine wichtige neue Ergänzung im konservativen Therapiespektrum des Orthopäden dar. Wenngleich das Haupteinsatzgebiet bisher spastische und dystone Bewegungsstörungen verschiedenster Ursachen umfasst, treten andere Indikationen, bei denen es zu einer muskulären Störung kommt, immer mehr hinzu. Damit begrenzt sich diese Behandlungsform nicht mehr ausschließlich auf neurologische Probleme. Nur durch die genaue Kenntnis des Wirkungsmechanismus und der Injektionstechnik wird diese Methode auch in der Orthopädie einen festen Stellenwert erhalten. Die Kombinierbarkeit mit weiteren konservativen Verfahren wie der Orthetik und der Gipsredression vermag dabei die Wirksamkeit zu erhöhen und zu verlängern. Jeder Orthopäde, der sich auch mit konservativen Behandlungsmaßnahmen befasst, sollte sich mit dieser Methode vertraut machen.

Abstract

Botulinum toxin A plays an important role in the conservative management of problems of the musculoskeletal system. The main indications for its use are disorders of muscle tone and spasticity of various origins, which makes botulinum toxin an important focal treatment in many neurological conditions. Nevertheless, every orthopaedic surgeon who is involved in the conservative management of muscular problems should be familiar with the indications as well as the pharmacology of the substance and its proper injection techniques. By a combination of botulinum toxin injections with a variety of other conservative measures, such as orthotics and plaster cast treatment, its effect can be enhanced and prolonged. Due to the reversibility of its action, exact dose adjustment to the individual is possible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2a–c
Abb. 3a–d
Abb. 4
Abb. 5a,b

Literatur

  1. Alvarez CM, Tredwell SJ, Keenan SP et al. (2005) Treatment of idiopathic clubfoot utilizing Botulinum A toxin. J Pediatr Orthop 25(2): 229–235

    Article  PubMed  Google Scholar 

  2. Aoki, K, Guyer B (2001) Botulinumtoxin type A and other botulinumtoxin serotypes: a comparative review of biochemical and pharmacological actions. Eur J Neurol 8: 21–29

    Article  PubMed  Google Scholar 

  3. Bakheit AMO, Severa S et al. (2001) Safety profile and efficacy of botulinumtoxin A in children with muscle spasticity. Dev Med Child Neurol 43: 234–238

    Article  PubMed  Google Scholar 

  4. Borodic G, Ferrante R, Pearce L (1994) Histologic assessment of dose related diffusion and muscle fiber response after therapeutic botulinumtoxin A injections. Mov Disord 9: 31–39

    Article  PubMed  Google Scholar 

  5. Borodic G, Johnson E et al. (1996) Botulinumtoxin therapy, immunologic resistance and problems with available materials. Neurology 46: 26–29

    PubMed  Google Scholar 

  6. Boyd R, Graham HK (1999) Objective measurement of clinical findings in the use of botulinumtoxin typeA for the management of children with cerebral palsy. Eur J Neurol 6: S23–S35

    Google Scholar 

  7. Brin M (1997) Spasticity: etiology, evaluation, management and the role of botulinumtoxin type A. Muscle Nerve (suppl 6): S208–S220

  8. Ceballos-Baumann A, Conrad B (2005) Bewegungsstörungen, 2. Aufl. Thieme, Stuttgart

  9. Corry I,Cosgrove AP,Duffy C (1999) Botulinumtoxin A in hamstring spasticity. Gait Posture 10: 206–210

    Article  PubMed  Google Scholar 

  10. Cosgrove A, Corry I, Graham HK (1994) Botulinumtoxin in the management of the lower limb in cerebral palsy. Dev Med Child Neurol 36: 386–396

    PubMed  Google Scholar 

  11. Davis EC, Barnes MP (2001)The use of botulinumtoxin in spasticity in: Barnes MP, Johnson GR (2001)Upper motor neuron syndrome and spasticity. Cambridge Univ. press, Cambridge, pp 206–222

    Google Scholar 

  12. Delgado MR, Wilson H, Johnston C et al. (2000) A preliminary report of the use of Botulinum toxin type A in infants with clubfoot. J Pediatr Orthop 20: 533–538

    Article  PubMed  Google Scholar 

  13. Gormley M, Gaebler-Spira D, Delgado M (2001) Use of botulinumtoxin type in pediatric patients with cerebral palsy. Child Neurol 16: 112–118

    Google Scholar 

  14. Gormley M, Krach L, Murr S (2004) Non-operative treatment. In: Gage JR (ed) The treatment of gait problems in cerebral palsy. Clinics in developmental medicine, No 164–165, Cambridge University press, pp 259–265

  15. Graham HK, Aoki KR, Autti-Rämö I et al. (2000) Recommendations for the use of botulinumtoxin type A in the management of cerebral palsy. Gait Posture 11: 67–79

    Article  PubMed  Google Scholar 

  16. Graham HK (2004) The management of deformity. In: Scrutton D, Damiano D, Mayston M (eds) Management of the motor disorders of children with cerebral palsy. Mc Keith press, Cambridge, pp 130–146

  17. Greene P, Fahn S (1994) Development of resistance to botulinumtoxin type A in patients with torticollis: Mov Disord. 9: 213–217

    Google Scholar 

  18. Heinen F, Bartens W (2001) Das Kind und die Spastik. Hans Huber, Bern

  19. Hesse S, Friedrich H, Domasch C(1992) Botulinumtoxin therapy for upper limb spasticity. J.Rehab Sci 5: 98–101

    Google Scholar 

  20. Hesse S, Mauritz KH (1997) Management of spasticity. Curr.Opin Neurol 10: 498–501

    Google Scholar 

  21. Jankovic J, Brin MF (1991) Therapeutic uses of Botulinumtoxin. N Engl J Med 3224: 1186–1194

    Google Scholar 

  22. Koman LA, Mooney JF, Smith BP et al. (1993) Management of cerebral palsy with botulinum-A toxin : preliminary investigation. J Pediatr Orthop 13: 489–495

    PubMed  Google Scholar 

  23. Koman LA, Mooney JF, Smith BP et al. (2000) Botulinumtoxin type A neuromuscular blockade in the treatment of lower extremity spasticity in cerebral palsy: a randomized double blind placebo controlled trial. J Pediatr Orthop 20: 108–115

    Article  PubMed  Google Scholar 

  24. Koman LA, Brashear A, Rosenfeld S et al. (2001) Botulinumtoxin type a neuromuscular blockade in the treatment of equinus foot deformity in cerebral palsy: a multicenter, open label clinical trial: Pediatrics 108: 1062–1071

    Google Scholar 

  25. Mejia NL, D at Vuong K, Lankovic J (2005) Long-term botulinumtoxin efficacy,safety and immunogenicity. Movement disorders 20(5): 592–597

    Article  PubMed  Google Scholar 

  26. Metaxiotis D, Siebel A, Doederlein L (2002)Repeated botulinumtoxin A injections in the treatment of spastic equinus foot. Clin Orthop Rel Res 394: 177–185

    Google Scholar 

  27. Molenaers G, Desloovere K, Eyssen M et al. (1999) Botulinumtoxin type A treatment of cerebral palsy: an integrated approach. Eur J Neurol 6: S51–S57

    Article  Google Scholar 

  28. Molenaers G, Desloovere K, De Cat J et al. (2001) Single event multilevel botulinumtoxin type A treatment and surgery: similarities and differences. Eur J Neurol 8 (suppl 5): 88–97

    Google Scholar 

  29. Molenaers G, Desloovere K, De Cat J (2004) Botulinumtoxin A bei der Behandlung der infantilen Zerebralparese. Orthopäde 33: 1119–1128

  30. Moore P, Naumann M (2003) Handbook of botulinumtoxin treatment, 2nd edn. Blackwell, Malden/MA

  31. Naumann M, Hefter H, Heinen F (1998) Botulinumtoxin-Wirkprinzip und klinische Anwendung. Unimed, Bremen

  32. Placzek R, Lindner MS et al. (2004) Die Therapie der chronischen Epicondylitis radialis mit Botulinumtoxin A. Z Orthop 142: 701–705

    Article  PubMed  Google Scholar 

  33. Reichel G (2001) Therapieleitfaden Spastik und Dystonien. Unimed, Bremen

  34. Rosales R, Arimura K, Takenaga S et al. (1996) Extrafusal and intrafusal muscle effects in experimental botulinumtoxin A injection. Muscle Nerve 19: 488–496

    Article  PubMed  Google Scholar 

  35. Russman B, Tilton A, Gormley M (1997) Cerebral palsy: a rational approach to a treatment protocol, and the role of botulinumtoxin in treatment. Muscle Nerve (Suppl 6): S181–S193

  36. Schantz E, Scott A (1981) Use of cristalline Type A Botulinumtoxin in medical research. In: Lewis G (ed) Biomedical aspects of Botulism. Academic press, New York, pp 143–150

  37. Scott A, Suzuki D (1988) Systemic toxicity of botulinumtoxin by intramuscular injection in the monkey. Mov Disord 9: 213–217

    Google Scholar 

  38. Shaari C, Sanders I (1993) Qualifying how location and dose of botulinumtoxin injections affect muscle paralysis. Muscle Nerve 16: 964–969

    Article  PubMed  Google Scholar 

  39. Sheean G (1998) Spasticity rehabilitation. Churchill communications, London

  40. Sutherland DA, Kaufman K, Wyatt M et al. (1996) Injection of botulinum-A toxin into gastrocnemius muscle of patients with cerebral palsy: a 3-D motion analysis study. Gait Posture 4: 269–279

    Article  Google Scholar 

Download references

Interessenkonflikt:

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Stiftung orthopädische Universitätsklinik Heidelberg

    L. Döderlein

  2. Stiftung orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstraße 200 a, 69118, Heidelberg

    L. Döderlein

Authors
  1. L. Döderlein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Döderlein.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Döderlein, L. Botulinumtoxin-Therapie in der Orthopädie. Orthopäde 35, 107–118 (2006). https://doi.org/10.1007/s00132-005-0902-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-005-0902-x

Schlüsselwörter

Keywords

Search

Navigation