A型肉毒毒素在先天性肌性斜颈治疗中的前瞻性应用研究

来源:用户上传      作者:汪城河　苏哲人　苏振民　林文雄　王 彪

　　[摘要]目的：Ρ炔煌剂量A型肉毒毒素（BTX-A）与传统保守方法治疗先天性肌性斜颈的临床疗效，评估A型肉毒毒素的有效性和安全性。方法：选择2018年1月-2018年7月笔者医院门诊就诊的先天性肌性斜颈患儿60例，按照不同治疗方法分为A组（BTX-A局部注射4 U/kg），B组（BTX-A局部注射2 U/kg），C组（对抗牵拉训练为主的传统保守治疗），每组各20例。对比各组不同时间节点肌肉厚度差值、肌肉长度差值以及患侧头肩角，评估各组临床疗效，记录各组不良反应发生情况。结果：治疗前和治疗后1、3、6个月，各组内肌肉厚度差值、长度差值随着治疗时间推移均呈递减状态，而患侧头肩角随着时间推移呈递增状态，组内对比差异有统计学意义（P<0.05），但每个时间节点以上指标组间比较差异无统计学意义（P>0.05），以上三个指标与疗效没有相关性（P>0.05）。三组疗效比较差异不显著（P>0.05）。A组有2例发生瘀青，1例出现注射当晚吞咽能力略有下降、未特殊处理，自行好转;B组有1例发生瘀青。C组无烫伤、肌肉断裂、颈椎损伤等不良情况发生。结论：先天性肌性斜颈选择A型肉毒毒素局部注射不良反应少，有效率高，可取得与传统保守方法相同的疗效，值得临床推广。
　　[关键词]A型肉毒毒素;先天性肌性斜颈;前瞻性;指标;疗效;保守治疗
　　[中图分类号]R682.1+2 [文献标志码]A [文章编号]1008-6455（2022）01-0001-05
　　Prospective Application Research of Botulinum Toxin Type A in the Treatment of Congenital Muscular Torticollis
　　WANG Chenghe1，2，SU Zheren1，SU Zhenmin2，LIN Wenxiong2，WANG Biao3
　　（1.FuJian Medical University，Fuzhou 350000，Fujian，China;2.Department of Plastic Surgery，Children's Hospital of Quanzhou，Teaching Hospital of FuJian Medical University，Quanzhou 362000，Fujian，China;3.Department of Plastic Surgery，The First Affiliated Hospital of Fujian Medical University，Fuzhou 350000，Fujian，China）
　　Abstract： Objective To compare the clinical efficacy of different doses of botulinum toxin type A （BTX-A） and traditional conservative methods in the treatment of congenital muscular torticollis， and to evaluate the efficacy and safety of botulinum toxin type A. Methods A total of 60 children with congenital muscular torticollis were treated in the outpatient department of the author's hospital from January 2018 to July 2018. They were divided into three groups according to different treatment methods， group A （local injection of BTX-A 4 U/kg），group B （local injection of BTX-A 2 U/kg），and group C （traditional conservative treatment based on anti-stretch training）， 20 cases in each group. The difference in muscle thickness， muscle length， and head and shoulder angle on the affected side at different time points in each group were compared， the clinical efficacy of each group was evaluated， and the occurrence of adverse reactions in each group was recorded. Results Before treatment and 1， 3， and 6 months after treatment， the difference in muscle thickness and length in each group decreased with time， while the head and shoulder angle on the affected side increased with time. The difference was statistically significant （P<0.05）， but there was no significant difference between groups in the above indexes at each time node （P>0.05）， and the above three indexes had no correlation with the curative effect （P>0.05）. There was no significant difference in curative effect among the three groups （P>0.05）. There were 2 cases of bruising in group A， 1 case had a slight decrease in swallowing ability on the night of injection， and it improved spontaneously without special treatment; 1 case of group B had bruising. There were no adverse events such as scald， muscle rupture and cervical spine injury in group C. Conclusion For congenital muscular torticollis， local injection of botulinum toxin type A has fewer adverse reactions and high efficacy， and can achieve the same efficacy as traditional conservative methods， which is worthy of clinical promotion.
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