Parratte B, Tatu L, Vuillier F, Diop M, Monnier G
Laboratoire d'Anatomie, Faculté de Médecine, Place St Jacques, 25030 Besançon, France.
Surg Radiol Anat. 2002 May;24(2):91-6. doi: 10.1007/s00276-002-0022-9.
Recent progress has been made in selective functional treatment of hypertonia of spastic origin by local injection of botulinum toxin into the muscles responsible for equinus foot dynamic deformation. The technical aspect of the intervention requires a strategy adapted to the individual patient. Good practice is founded on precise knowledge of the intramuscular nerve distribution of end plate zones, since the target organ of the toxin is the motor end plate. Knowledge about the location of motor end plates, which differs according to the structure of the muscle in question, remains rather poor. Through macroscopic and stereoscopic microscopic dissection of the nerve courses in the triceps surae muscular group in 40 legs, we have ascertained in more detail the distribution of motor end plates, which appear to be more numerous in certain zones of the muscle bellies. These zones were measured morphometrically and divided into segments which are expressed in percentages of a standard leg length. We maintain that these zones are the injection sites most likely to guarantee the best treatment efficacy.
通过向导致马蹄足动态畸形的肌肉局部注射肉毒杆菌毒素，在痉挛性高张力的选择性功能治疗方面取得了最新进展。干预的技术层面需要一种适合个体患者的策略。良好的实践基于对终板区肌肉内神经分布的确切了解，因为毒素的靶器官是运动终板。关于运动终板位置的知识，因其所涉及肌肉的结构不同而有所差异，目前仍相当匮乏。通过对40条腿的小腿三头肌肌群神经走行进行宏观和立体显微镜解剖，我们更详细地确定了运动终板的分布，其在肌腹的某些区域似乎更为密集。对这些区域进行形态测量并划分为若干节段，以标准腿长的百分比表示。我们认为这些区域是最有可能保证最佳治疗效果的注射部位。
