A型肉毒毒素治疗先天性肌性斜颈的初步观察
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摘要
目的探讨局部应用A型肉毒毒素对于先天性肌性斜颈(CMT)的临床疗效,并评估其安全性。方法自2014年8月至2017年2月,共入选由门诊就诊患儿26例,按随机数字表法,将符合入选标准的患儿(年龄<6个月)随机分为A、B两组;A组为单点注射,B组为3点注射。采用A型肉毒毒素局部注射胸锁乳突肌(4 U/kg),同时测量两侧肌肉长度并采用超声测量肌肉厚度,比较治疗前后的变化。结果本组共26例患儿,剔除尚未完成治疗者4例及治疗后未能按时随访者4例,最后18例患儿进入最终数据统计分析。整体对比分析发现,治疗后1个月,两组在肌肉厚度上比较,其差异无统计学意义;治疗后3、6个月,其差异均具有统计学意义(P<0.05)。统计学比较,在肌肉长度上的变化与肌肉厚度变化情况一致。通过A、B组内数据的统计学分析发现,B组与整体数据变化相同,A组则不同。不良反应上,1例患儿注射当日出现吸吮稍无力,3例患儿出现局部皮下淤青,均自行好转。结论采用A型肉毒毒素局部注射治疗CMT,可获得良好的临床效果;初步研究显示,本方法安全性较高,并发症较少,值得临床推广。
Objective To explore the clinical efficacy and safety of botulinum toxin type A in the treatment of congenital muscular torticollis. Methods From August 2014 to February 2017, 26 children who met the inclusion criteria(age less than 6 months) were selected in outpatient visits. According to a random number table, all children were randomly divided into two groups. One group was given single point injections and the other was given three-point injections. Botulinum toxin type A was locally injected to the sternocleidomastoid(4 u/kg). The muscle length and thickness of both sides were measured before and after treatment. Results Among the 26 children, 4 patients whodid not complete treatment and 4 patients whowere not followed up on time were excluded. Therefore, 18 cases were analyzed in the final data statistics. In general, there was no statistically significant difference in muscle thickness at 1 month after treatment. At 3 and 6 months after treatment, the difference was statisticallysignificant(P<0.05). There was one case ofslightlyweak suction on the dayofinjection and 3 children had local subcutaneous bruises. All cases improved on their own. Statistical analysis showed that changes in muscle length were consistent with changesinmusclethickness.Thechangesinthethree-pointinjectiongroupwerethesameastheintheoveralldata,butthesingleinjection group was different. Conclusion Local injection of botulinum toxin type A is an effective treatment for congenital muscular torticollis, with good clinical effect. The clinical preliminary study shows that this method is safe with fewcomplications and is worth promoting in clinic.
Objective To explore the clinical efficacy and safety of botulinum toxin type A in the treatment of congenital muscular torticollis. Methods From August 2014 to February 2017, 26 children who met the inclusion criteria(age less than 6 months) were selected in outpatient visits. According to a random number table, all children were randomly divided into two groups. One group was given single point injections and the other was given three-point injections. Botulinum toxin type A was locally injected to the sternocleidomastoid(4 u/kg). The muscle length and thickness of both sides were measured before and after treatment. Results Among the 26 children, 4 patients whodid not complete treatment and 4 patients whowere not followed up on time were excluded. Therefore, 18 cases were analyzed in the final data statistics. In general, there was no statistically significant difference in muscle thickness at 1 month after treatment. At 3 and 6 months after treatment, the difference was statisticallysignificant(P<0.05). There was one case ofslightlyweak suction on the dayofinjection and 3 children had local subcutaneous bruises. All cases improved on their own. Statistical analysis showed that changes in muscle length were consistent with changesinmusclethickness.Thechangesinthethree-pointinjectiongroupwerethesameastheintheoveralldata,butthesingleinjection group was different. Conclusion Local injection of botulinum toxin type A is an effective treatment for congenital muscular torticollis, with good clinical effect. The clinical preliminary study shows that this method is safe with fewcomplications and is worth promoting in clinic.
引文
[1]Joyce MB,de Chalain TM.Treatment of recalcitrant idiopathic muscular torticollis in infants with botulium toxin type a[J].J Craniofac Surg,2005,16(2):321-327.
[2]杜青,陈蜒,沈品泉,等.先天性肌性斜颈早期康复治疗的疗效探讨[J].中华物理医学与康复杂志,2005,27(6):370-372.
[3]Tatli B,Aydinli N,Caliskan M,et al.Congenital muscular torticollis evaluation and classification[J].Pediatr Neurol,2006,34(1):41-44.
[4]Schertz M,Zuk L,Zin S,et al.Motor and cognitive development at one-year follow-up in infants with torticollis[J].Early Hum Dev,2008,84(1):9-14.
[5]Ohman A,Nilsson S,Lagerkvist AL,et al.Are infants with torticollis at risk for having a delay in achieving early motor milestones compared with a control group of healthy infants?[J].Dev Med Child Neurol 2009,51(7):545-550.
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[7]Oleszek JL,Chang N,Apkon SD,et al.Botulinum toxin type a in the treatment of children with congenital muscular torticolis[J].Am J Phys Med Rehabil,2005,84(10):813-816.
[8]Han JD,Kim SH,Lee SJ,et al.The thickness of the sternocleidomastoid muscle as a prognostic factor for congenital muscular torticollis[J].Ann Rehabil Med,2011,35(3):361-368.
[9]Sinn CN,Rinaldi RJ.Treatment with botulinum toxin type a in infants with refractory congenital muscular torticollis:a 10-year retrospective study[J].PM R,2016,8(9S):S152-S153.
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[11]侯元婕,薛克修.Ⅳ型胶原在肌性斜颈中的表达及意义[J].新乡医学院学报,2006,23(3):233-235.
[12]唐盛平,周亚玲,刘正全,等.先天性肌性斜颈病变组织中细胞凋亡的研究[J].临床小儿外科杂志,2007,6(1):12-15.
[13]高福堂,唐盛平,王帅印,等.先天性肌性斜颈病变组织中脂肪增生与纤维化[J].中华小儿外科杂志,2012,33(6),408-412.
[14]文卫东,袁芳,侯一平.A型肉毒素对腮腺分泌功能影响的研究[J].中华口腔医学杂志,2009,44(1):38-40.
[15]杨雄,杨栋,侯腾,等.A型肉毒毒素注射引起大鼠前列腺增生模型细胞凋亡的研究[J].临床泌尿外科杂志,2011,26(5),389-391.
[16]颜彤彤,陈敏亮,马奎,等.A型肉毒毒素对成纤维细胞中α平滑肌肌动蛋白和肌球蛋白-Ⅱ表达的影响[J].中华整形外科杂志,2014,30(2),118-121.
[17]李卫华,李德水,高玉伟,等.A型肉毒毒素可抑制人增生性瘢痕成纤维细胞增殖和胶原蛋白的合成[J].中国组织工程研究,2012,16(20):3667-3670.
[18]Dudkiewicz,Ganel A,Blankstein A.Congenital muscular torticollis in infants:ultrasound-assisted diagnosis and evaluation[J].J Pediatr Orthop 2005,25(6):812-814.
[19]IBR.Odderson.Botulinumtoxin injection guide[M].New York:Demos Medical Publishing,2008:20-22,61-62.
[2]杜青,陈蜒,沈品泉,等.先天性肌性斜颈早期康复治疗的疗效探讨[J].中华物理医学与康复杂志,2005,27(6):370-372.
[3]Tatli B,Aydinli N,Caliskan M,et al.Congenital muscular torticollis evaluation and classification[J].Pediatr Neurol,2006,34(1):41-44.
[4]Schertz M,Zuk L,Zin S,et al.Motor and cognitive development at one-year follow-up in infants with torticollis[J].Early Hum Dev,2008,84(1):9-14.
[5]Ohman A,Nilsson S,Lagerkvist AL,et al.Are infants with torticollis at risk for having a delay in achieving early motor milestones compared with a control group of healthy infants?[J].Dev Med Child Neurol 2009,51(7):545-550.
[6]?hman A,Beckung E.Children who had congenital torticollis as infants are not at higher risk for a delay in motor development at preschool age[J].PM R,2013,5(10):850-855.
[7]Oleszek JL,Chang N,Apkon SD,et al.Botulinum toxin type a in the treatment of children with congenital muscular torticolis[J].Am J Phys Med Rehabil,2005,84(10):813-816.
[8]Han JD,Kim SH,Lee SJ,et al.The thickness of the sternocleidomastoid muscle as a prognostic factor for congenital muscular torticollis[J].Ann Rehabil Med,2011,35(3):361-368.
[9]Sinn CN,Rinaldi RJ.Treatment with botulinum toxin type a in infants with refractory congenital muscular torticollis:a 10-year retrospective study[J].PM R,2016,8(9S):S152-S153.
[10]薛克修,严海燕,刘同喜.先天性肌性斜颈胸锁乳突肌I、Ⅲ型胶原的免疫组化研究[J].新乡医学院学报,2005,22(6):530-532.
[11]侯元婕,薛克修.Ⅳ型胶原在肌性斜颈中的表达及意义[J].新乡医学院学报,2006,23(3):233-235.
[12]唐盛平,周亚玲,刘正全,等.先天性肌性斜颈病变组织中细胞凋亡的研究[J].临床小儿外科杂志,2007,6(1):12-15.
[13]高福堂,唐盛平,王帅印,等.先天性肌性斜颈病变组织中脂肪增生与纤维化[J].中华小儿外科杂志,2012,33(6),408-412.
[14]文卫东,袁芳,侯一平.A型肉毒素对腮腺分泌功能影响的研究[J].中华口腔医学杂志,2009,44(1):38-40.
[15]杨雄,杨栋,侯腾,等.A型肉毒毒素注射引起大鼠前列腺增生模型细胞凋亡的研究[J].临床泌尿外科杂志,2011,26(5),389-391.
[16]颜彤彤,陈敏亮,马奎,等.A型肉毒毒素对成纤维细胞中α平滑肌肌动蛋白和肌球蛋白-Ⅱ表达的影响[J].中华整形外科杂志,2014,30(2),118-121.
[17]李卫华,李德水,高玉伟,等.A型肉毒毒素可抑制人增生性瘢痕成纤维细胞增殖和胶原蛋白的合成[J].中国组织工程研究,2012,16(20):3667-3670.
[18]Dudkiewicz,Ganel A,Blankstein A.Congenital muscular torticollis in infants:ultrasound-assisted diagnosis and evaluation[J].J Pediatr Orthop 2005,25(6):812-814.
[19]IBR.Odderson.Botulinumtoxin injection guide[M].New York:Demos Medical Publishing,2008:20-22,61-62.