Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, AP-HP, University of Versailles Saint Quentin, 104 Boulevard Raymond Poincaré, 92380 Garches, France.
Muscle Nerve. 2012 Oct;46(4):531-4. doi: 10.1002/mus.23410.
Electrophysiological or ultrasound guidance can facilitate botulinum toxin A (BoNt-A) injection accuracy, but clinical landmarks and palpation are often used for superficial muscles. We evaluated the accuracy of manual needle placement in the gastrocnemius muscles (GC) guided only by anatomical landmarks and palpation.
Bilateral limbs from 30 cadavers were used to evaluate ink injection into the GC. One anatomist and one orthopedic surgeon verified the accuracy of manual needle placement postinjection by calf muscle dissection. Injection was considered a failure if the ink was not located in the head of the target GC.
One hundred twenty-one practitioners were evaluated. Fifty-two injections were successful (43%), and 69 failed (57%). This result was unrelated to injector experience (P = 0.097).
Our findings show a poor success rate, regardless of injector experience. Therefore, muscle palpation and anatomical landmarks are insufficient to ensure the accuracy of BoNt-A injections, even for large, superficial muscles.
电生理学或超声引导可以提高肉毒毒素 A（BoNt-A）注射的准确性，但临床标志和触诊通常用于浅层肌肉。我们评估了仅通过解剖标志和触诊引导下，手动将针放置在比目鱼肌（GC）中的准确性。
使用 30 具尸体的双侧肢体来评估将墨水注入 GC 中的情况。一名解剖学家和一名矫形外科医生在注射后通过小腿肌肉解剖来验证手动放置针的准确性。如果墨水未位于目标 GC 的头部，则认为注射失败。
评估了 121 名从业者。52 次注射成功（43%），69 次失败（57%）。这一结果与注射者的经验无关（P=0.097）。
我们的研究结果表明，成功率较低，无论注射者的经验如何。因此，肌肉触诊和解剖标志不足以确保 BoNt-A 注射的准确性，即使是对于大的、浅层肌肉也是如此。
