书写痉挛患者与健康对照者上肢主动活动范围测量的差异。
Differences in active range of motion measurements in the upper extremity of patients with writer's cramp compared with healthy controls.
作者信息
Srivanitchapoom Prachaya, Shamim Ejaz A, Diomi Pierre, Hattori Takaaki, Pandey Sanjay, Vorbach Sherry, Park Jung E, Wu Tianxia, Auh Sungyoung, Hallett Mark
机构信息
Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA; Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA; Department of Neurology, Mid-Atlantic Permanente Research Institute, Kaiser Permanente, Rockville, MD, USA.
出版信息
J Hand Ther. 2016 Oct-Dec;29(4):489-495. doi: 10.1016/j.jht.2016.02.001. Epub 2016 Feb 18.
STUDY DESIGN
Exploratory case-control study.
INTRODUCTION
Writer's cramp (WC) is a type of focal hand dystonia. The central nervous system plays a role in its pathophysiology, but abnormalities in the affected musculoskeletal components may also be relevant.
PURPOSE OF THE STUDY
We compared the active range of motion (ROM) in patients with WC and healthy volunteers (HVs) and correlated the findings with disease duration and severity.
METHODS
Affected limb joints were measured with goniometers. Patients were assessed at least 3 months after their last botulinum toxin (botulinum neurotoxin) injection, and strength was clinically normal. t tests were used to compare the ROMs of WC with matched HVs. The Spearman correlation coefficient assessed the relationship of active ROMs to the disease duration and handwriting subscore of the Dystonia Disability Scale.
RESULTS
ROMs of D1 metacarpophalangeal (MCP) joint extension as well as D2 and D5 MCP flexion were significantly smaller in WC, and distal interphalangeal joint extension in D3 and D5 was significantly greater compared with HVs. There were negative correlations between D2 MCP flexion and disease duration and with Dystonia Disability Scale.
DISCUSSION
Abnormalities in ROMs in WC were found. Severity and disease duration correlated with reduced D2 MCP flexion. This may be related to intrinsic biomechanical abnormalities, co-contraction of muscles, or a combination of subclinical weakness and atrophy from repeated botulinum neurotoxin injections.
CONCLUSIONS
Hand biomechanical properties should not be ignored in the pathophysiology of WC.
LEVEL OF EVIDENCE
2c.
研究设计
探索性病例对照研究。
引言
书写痉挛（WC）是一种局限性手部肌张力障碍。中枢神经系统在其病理生理学中起作用，但受影响的肌肉骨骼成分异常也可能相关。
研究目的
我们比较了书写痉挛患者和健康志愿者（HV）的主动活动范围（ROM），并将结果与疾病持续时间和严重程度相关联。
方法
使用量角器测量患侧肢体关节。患者在最后一次注射肉毒杆菌毒素（肉毒杆菌神经毒素）至少3个月后接受评估，且肌力在临床上正常。采用t检验比较书写痉挛患者与匹配的健康志愿者的活动范围。Spearman相关系数评估主动活动范围与疾病持续时间和肌张力障碍残疾量表书写亚评分之间的关系。
结果
与健康志愿者相比，书写痉挛患者的D1掌指（MCP）关节伸展以及D2和D5 MCP屈曲的活动范围明显较小，D3和D5的远端指间关节伸展明显更大。D2 MCP屈曲与疾病持续时间以及肌张力障碍残疾量表之间存在负相关。
讨论
发现书写痉挛患者存在活动范围异常。严重程度和疾病持续时间与D2 MCP屈曲减少相关。这可能与内在生物力学异常、肌肉共同收缩，或反复注射肉毒杆菌神经毒素导致的亚临床肌无力和萎缩的组合有关。
结论
在书写痉挛的病理生理学中，手部生物力学特性不应被忽视。
证据水平
2c。
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