Division of Orthopedic Surgery, Weill Cornell Medicine, Sidra Medicine, Doha, Qatar.
Division of Orthopedic Surgery, Weill Cornell Medicine, Sidra Medicine, Doha, Qatar.
Med Hypotheses. 2019 Jan;122:126-128. doi: 10.1016/j.mehy.2018.11.002. Epub 2018 Nov 9.
In cerebral palsy (CP), the spastic motor type is most common, associated with a velocity-dependent increase in muscle stiffness that precedes the development of fixed muscle contracture - a permanent shortening of the muscle tendon unit even when relaxed. Intra-muscular injections of botulinum toxin type A (BTX-A) have become popular for the treatment of spastic muscle contractures but unfortunately its use has not resulted in long-term functional benefits and, paradoxically, has been associated with a persistent loss of contractile material. Recent biomechanical work has shown that the stiffness of the CP muscle increases in proportion to total collagen content within the perimysial extra-cellular matrix. Thus, rather than the use of tone-reducing agents, we hypothesize that the focal use of a selective collagenase, injected into spastic muscle at an appropriate dilution and concentration, may serve to reduce the extent of muscle contracture, improving clinical range of motion and perhaps sarcomere length.
在脑瘫（CP）中，痉挛型最为常见，与肌肉僵硬的速度依赖性增加有关，这种增加先于固定性肌肉挛缩的发展——即使在放松状态下，肌肉肌腱单位也会发生永久性缩短。肉毒毒素 A 型（BTX-A）的肌内注射已成为治疗痉挛性肌肉挛缩的常用方法，但不幸的是，其使用并未带来长期的功能益处，而且矛盾的是，它与收缩物质的持续丧失有关。最近的生物力学研究表明，CP 肌肉的僵硬程度与肌周细胞外基质中的总胶原含量成比例增加。因此，我们假设，与其使用降低张力的药物，不如将选择性胶原酶以适当的稀释度和浓度注射到痉挛性肌肉中进行局部使用，可能有助于减少肌肉挛缩的程度，改善临床活动范围，甚至可能改善肌节长度。
