颈部肌张力障碍临床分型及肉毒毒素疗效

Clinical classification of cervical dystonia and its treatment using Chinese botulinum toxin type A

目的根据颈部肌张力障碍患者的不同临床特点进行临床分型并观察不同类型患者A型肉毒毒素治疗效果。方法分析186例颈部肌张力障碍患者头颈部的异常姿势,进行临床分型,并对152例患者采用A型肉毒毒素肌肉注射治疗。结果186例颈部肌张力障碍患者头颈部异常姿势中,单纯扭转型88例(47.3%),侧倾型10例(5.4%),前屈型1例(0.5%),后仰型12例(6.5%),单纯震颤型5例(2.7%),旋转前屈型26例(14.0%),旋转后仰Ⅰ型13例(7.0%),旋转后仰Ⅱ型31例(16.7%)。有152例局部注射A型肉毒毒素治疗颈部肌张力障碍,其中10例资料不完整者剔除。临床症状显著缓解121例(85.2%),其中单纯扭转型缓解率最高,为93.4%(71/76),旋转后仰Ⅱ型缓解率最低(43.8%,7/16)。最常见的副作用是注射局部的肌肉疼痛和颈肌无力。结论熟悉颈部肌张力障碍的临床分型,精确定位受累肌肉及注射适宜剂量的肉毒毒素是有效治疗的关键。

Objective To study different clinical manifestations of cervical dystonia patients and the therapeutic efficacy of Chinese botulinum toxin type A （CBTX-A） in different types of patients. Methods The clinical history of 186 patients and their cervical posture abnormalities were analyzed, and classified according to their clinical features. One hundred and fifty-two patients were muscularly injected with CBTXA local injections. Results Rotational torticollis was identified in 88 patients （47.3%）, laterocollis in 10 （5.4%） , anterocollis in 1 （ 0.5 % ） , retrocollis in 12 （ 6.5 % ） , pure tremor in 5 （ 2.7 % ）, anterocollis with rotation in 26 （14.0%）, retrocollis with rotation type I in 13 （7.0%）, and retrocollis with rotation type Ⅱ in 31 （ 16.7% ）. Considerable improvement of symptoms for the cervical dystonia with CBTX-A injections were observed in 121 patients （85%）. The overall effective rate was 93.4% （71/76） in pure rotational type of patients, while 43.8% （7/16） in retrocollis with rotation type Ⅱ. The most adverse effects of CBTX-A injections included slight pain due to needle injection and neck weakness. Conclusion Familiarity with clinical manifestations and classification of cervical dystonia, correct selection of muscle involved and appropriate dose of CBTX-A used should be the implementation of effective therapy.