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.
引文
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