Fregene Alero, Ditmars Donald, Siddiqui Aamir
Division of Plastic Surgery, Henry Ford Hospital, Detroit, MI, USA.
J Hand Surg Am. 2009 Mar;34(3):446-52. doi: 10.1016/j.jhsa.2008.11.026.
Raynaud's phenomenon is an exaggerated vasospastic response that causes pallor and cyanosis. In the hand, it results in pain, disability, and the need for amputation. Current accepted medical and surgical treatments are not uniformly successful and have their inherent morbidities. Reports in the literature describe the use of botulinum toxin type A (BTX-A) for the treatment of vasospastic ischemia of the digits. We report the results of the treatment of recalcitrant digital ischemia with BTX-A in our institution.
We performed a retrospective chart review between January 2003 and February 2007. All patients presented with a diagnosis of Raynaud's phenomenon with worsening pain, discoloration, or nonhealing wound of the hand. Patients received BTX-A injections into the perineurovascular tissue of the wrist or the distal palm, or along the digit. Outcomes measured included pain rating, digit color and appearance, transcutaneous oxygen saturation, and healing of chronic ulcers.
Twenty-six patients were treated, with a total of 55 treatment encounters. Patients were observed for an average of 18 months. Statistically significant improvements were noted for pain score and digit transcutaneous oxygen saturation measurements after treatment (p < .05). We found smokers and women were more likely to have improved coloration and appearance after injections. Complications included localized injection-related pain and transient intrinsic muscle weakness.
Botulinum toxin type A significantly improves pain and improves healing in Raynaud's patients with few complications. BTX-A was found to be a safe and useful treatment option for vasospastic digital ischemia.
雷诺现象是一种过度的血管痉挛反应，会导致皮肤苍白和发绀。在手部，它会引起疼痛、功能障碍以及截肢需求。目前公认的药物和手术治疗并非都能取得成功，且都有其固有的发病率。文献报道了使用A型肉毒杆菌毒素（BTX-A）治疗手指血管痉挛性缺血。我们报告了在我们机构中使用BTX-A治疗顽固性手指缺血的结果。
我们对2003年1月至2007年2月期间的病历进行了回顾性分析。所有患者均被诊断为雷诺现象，伴有手部疼痛加剧、皮肤变色或伤口不愈合。患者接受BTX-A注射到手腕或手掌远端的神经血管周围组织，或沿着手指进行注射。测量的结果包括疼痛评分、手指颜色和外观、经皮氧饱和度以及慢性溃疡的愈合情况。
共治疗了26例患者，总计进行了55次治疗。患者平均观察了18个月。治疗后疼痛评分和手指经皮氧饱和度测量有统计学意义的改善（p <.05）。我们发现吸烟者和女性在注射后皮肤颜色和外观改善的可能性更大。并发症包括局部注射相关疼痛和短暂的固有肌无力。
A型肉毒杆菌毒素能显著改善雷诺病患者的疼痛并促进愈合，且并发症较少。BTX-A被发现是治疗血管痉挛性手指缺血的一种安全有效的选择。
