书写痉挛责任肌群的认定及肉毒毒素治疗的疗效观察

The identification of responsible muscle group for writer's cramp and the therapeutic effectiveness of Botulinum toxin injection

目的 寻找引起患者书写痉挛 (writer scramp)并导致字迹抖动不清的主要责任肌群 ,并同时观察局部注射肉毒毒素 A (botulinumtoxin A ,BTX A)对书写痉挛病症的治疗效果及副反应发生情况。方法 通过对前臂肌群的选择性运动 ,判断各肌群对书写痉挛症状的影响 ,并初步认定责任肌群 ,然后用维库溴铵对初步确定的责任肌群进行选择性注射 ,以进一步确定引起书写痉挛的主要责任肌群 ,最后对已确定的主要责任肌群进行BTX A多点注射 ,观察其疗效及副反应发生情况。结果 本研究发现 ,当前臂旋转肌群运动时会加重书写痉挛症状 ,对该群肌肉注射维库溴铵后可消除痉挛症状。当对旋转肌群进行BTX A注射后 ,受试的 3例患者 (共 5侧患肢 )症状全部得到改善 ,无一例发生可察觉的握力减退及垂腕等副反应。结论 前臂旋转肌群是导致书写痉挛并致使字迹抖动不清的主要责任肌群 ,对其进行BTX A选择性多点注射可获得满意疗效 ,同时还可避免握力减退及垂腕等副反应的发生。

Objective To identify the muscle group responsible for writer's cramp, and evaluate the therapeutic effectiveness of local injection of botulinum toxin. Methods The muscles responsible for hand dystonia was first recognized by selective movement of different muscle groups in the antebrachial region. Vecuronim bromide was then injected into the candidate muscle group to further ascertain its correlation with hand convulsion. Finally the selected muscle group was given injection of BTX A in multiple points to investigate the efficacy and potential side effects. Results Symptom of writer's cramp became worse after the selective exercises and was improved after the vecuronim bromide injection in the rotatory muscles. All five sick arms showed great improvement in hand writing without finger drop and hand weakness after the BTX A injection. Conclusion Botulinum toxin injections into forearm rotatory muscles caused definite improvement in hand writing, and had no significant side effects.