小腿肌性肥大分型及应用肉毒毒素注射塑形的临床研究

Clinical study of calf muscular hypertrophy classification and botulinum toxin injection

目的以小腿肌性肥大分型为依据制定肉毒毒素治疗小腿肌性肥大的个性化方案,并观察临床疗效。方法通过临床测量及B超等对受试者小腿特点进行普查并进行分型,回顾各类型受试者的诊疗数据,随访其注射后效果,统计受试者满意度。结果本组共纳入小腿肌性肥大受试者154例。按统计数据差异分为4种类型:Ⅰ型,腓侧突出型,腓肠肌外侧头及(或)比目鱼肌外侧肌群肥大;Ⅱ型,胫侧突出型,腓肠肌内侧头及(或)比目鱼肌内侧肌群肥大;Ⅲ型:全突出型,腓肠肌内外侧头及(或)比目鱼肌内外侧肌群肥大;Ⅳ型:不对称性型,两侧肌肉均肥大且不对称。收集按分型实施个性化肉毒毒素注射治疗受试者47例。平均随访4.5个月,注射后小腿形态美观,第2个月时小腿最粗围度减少(1.88±0.49)cm,受试者满意度为92.8%,未出现肌肉萎缩等严重并发症。结论综合测量后将小腿肥大分为4型,采用不同的注射方法,可获得满意的临床效果。

Objective To establish an individualized scheme based on the classification of calf muscular hypertrophy and to explore the clinical efficacy of botulinum toxin injections. Methods The calf circumference of all patients was measured and the muscle thickness was detected by B-ultrasonic examination to make a classification. Botulinum toxin was injected into the subjects＇ calves. The diagnosis and treatment data were retrospectively reviewed, and the efficacy of botulinum toxin injection and patients＇ satisfaction were evaluated. Results A total of 154 patients with calf muscular hypertrophy were involved in the study. Patients were divided into four types, according to the statistical data. Within the type Ⅰ group were cases of peroneal protrusion of the caput laterale musculi gastrocnemii and/or hypertrophic lateral soleus muscle. The type Ⅱ group included cases of tibial protrusion or protrution in the medial caput of the gastrocnemius and/or hypertrophic medial soleus muscle. The type Ⅲ group was for cases of full protrusion of the internal and external muscle group of the gastrocnemius and/or hypertrophic musculi soleus. Finally, in the type Ⅳ group were cases of asymmetry, or cases in which both sides of the muscles were hypertrophic and asymmetrical. Forty-seven patients received individualized botulinum toxin injections according to their classifications. The average follow-up duration was 4.5 months. After injection, the appearance of the calves was natural and well-defined, with no appearance of defect. At the second month, the thickest circumference of the calf had reduced（1.88 ± 0.49） cm. Patient satisfaction was 92.8%. No serious complications, such as muscular atrophy, occurred. Conclusion Muscular hypertrophy of the calf was classified into four types based on comprehensive measurements. Individualized botulinum toxin injections can obtain satisfactory results.