Furusawa Yoshihiko, Hanakawa Takashi, Mukai Yohei, Aihara Yuki, Taminato Tomoya, Iawata Yasuyuki, Takei Tomohiko, Sakamoto Takashi, Murata Miho
Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-higashi-cho, Kodaira, Tokyo, 187-8551, Japan; Department of Neurology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Kofu, 409-3898, Japan.
Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo, 187-8551, Japan.
Parkinsonism Relat Disord. 2015 Jul;21(7):765-70. doi: 10.1016/j.parkreldis.2015.02.027. Epub 2015 May 2.
We previously classified camptocormia of Parkinson's disease (PD) into upper and lower types based on the inflection point, and reported improvement of upper camptocormia after lidocaine injection into the external oblique. However, the exact pathophysiology of this phenomenon remains obscure.
Surface electromyography (sEMG) was recorded in 11 PD patients with upper camptocormia, 11 PD patients with lower camptocormia, and 10 age-matched PD patients without postural deformity. Electrodes were positioned above the external oblique, hip flexors and paraspinal muscles at Th11 level bilaterally. Recording commenced with the patient in supine position on a tilt table, and continued when the table was tilted up to vertical position. Lidocaine was injected into the external oblique in patients with upper camptocormia and the psoas major in patients with lower camptocormia.
All patients with upper and lower camptocormia developed the corresponding camptocormic posture during tilt up. The onset of camptocormic posture was preceded by the appearance of sEMG activity in the external oblique in 10 out of 11 patients with upper camptocormia, but less frequently in patients with lower camptocormia and the controls. Hip flexors sEMG activity was recorded in almost all patients. Posture was improved in 8 out of 9 patients with upper camptocormia, and 9 out of 11 patients with lower camptocormia following injections of lidocaine.
The results suggest the external oblique is involved, at least in part, in the development of upper camptocormia. Although EMG findings cannot differentiate pathogenicity, the psoas major is probably involved in lower camptocormia.
我们之前根据拐点将帕金森病（PD）的camptocormia分为上下型，并报道了在外斜肌注射利多卡因后上型camptocormia有所改善。然而，这一现象的确切病理生理学仍不清楚。
对11例上型camptocormia的PD患者、11例下型camptocormia的PD患者以及10例年龄匹配无姿势畸形的PD患者进行表面肌电图（sEMG）记录。电极双侧置于胸11水平的外斜肌、髋屈肌和椎旁肌上方。患者仰卧在倾斜台上开始记录，当台面倾斜至垂直位置时继续记录。对上型camptocormia患者在外斜肌注射利多卡因，对下型camptocormia患者在腰大肌注射利多卡因。
所有上型和下型camptocormia患者在倾斜过程中均出现相应的camptocormic姿势。11例上型camptocormia患者中有10例在camptocormic姿势出现之前外斜肌出现sEMG活动，但在下型camptocormia患者和对照组中出现的频率较低。几乎所有患者均记录到髋屈肌sEMG活动。注射利多卡因后，9例上型camptocormia患者中有8例姿势改善，11例下型camptocormia患者中有9例姿势改善。
结果表明外斜肌至少部分参与了上型camptocormia的发生。虽然肌电图结果不能区分致病性，但腰大肌可能参与了下型camptocormia的发生。
