Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
PM R. 2010 Jul;2(7):642-6. doi: 10.1016/j.pmrj.2010.05.002.
To determine if ultrasound (US) localization is equivalent to surface landmark localization to identify botulinum toxin injection targets for forearm muscle spasticity.
Observational.
Outpatient spasticity clinic in a tertiary care center.
Eighteen patients with upper-extremity flexor spasticity that interferes with function were included. Individuals with severe fixed contractures or traumatic injury of the involved forearm were excluded.
Flexor pollicis longus, flexor carpi radialis, pronator teres, and flexor digitorum superficialis (FDS) were identified by 2 separate localization techniques: the method of Delagi et al for flexor carpi radialis, pronator teres, and flexor pollicis longus; and a surface landmark technique by Bickerton et al to identify the 4 muscle bellies of FDS. Proximodistal and lateral (radial) coordinates were recorded relative to a landmark line from the medial epicondyle to pisiform bone, and percentage of landmark line distance was calculated. After surface measurements were collected, the best point for injection was determined by using real-time US with a 12-MHz linear transducer. US measurements were recorded by using the same landmark line system.
Localization techniques were compared by using the Wilcoxon signed rank test. One-sample t-tests compared surface-mapped lateral coordinates to US-derived lateral coordinates with controls for multiple testing. Significant differences were observed between surface and US proximodistal and lateral coordinates for several flexor muscles.
US should be considered as an adjunct for localization in patients with upper-limb spasticity. US can improve accuracy of toxin placement and help to avoid injection into vascular and nerve structures.
确定超声（US）定位是否等同于体表定位，以确定前臂肌肉痉挛的肉毒毒素注射靶点。
观察性研究。
三级医疗中心的门诊痉挛诊所。
18 例上肢屈肌痉挛性疾病患者，这些疾病影响了功能。严重固定性挛缩或受累前臂创伤性损伤的患者被排除在外。
通过 2 种单独的定位技术来识别指浅屈肌、桡侧腕屈肌、旋前圆肌和指深屈肌（FDS）：Delagi 等人的桡侧腕屈肌、旋前圆肌和指浅屈肌的方法；Bickerton 等人的体表标志技术来识别 FDS 的 4 个肌腹。近-远侧和外侧（桡侧）坐标相对于从内上髁到豌豆骨的标志线记录，并计算标志线距离的百分比。表面测量收集后，使用带有 12MHz 线性换能器的实时 US 确定最佳注射点。US 测量通过使用相同的标志线系统记录。
使用 Wilcoxon 符号秩检验比较定位技术。单样本 t 检验比较了表面映射的外侧坐标与 US 衍生的外侧坐标与多测试的对照。在几个屈肌中，表面和 US 近-远侧和外侧坐标之间存在显著差异。
US 应被视为上肢痉挛患者定位的辅助手段。US 可以提高毒素放置的准确性，并有助于避免注射到血管和神经结构中。
