Article

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.

Langue : ANGLAIS