Gomes André Luiz Salcedo, Mello Francisco Falleiros de, Cocicov Neto Jorge, Benedeti Marcelo Causin, Modolo Luis Felipe Miras, Riberto Marcelo
Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto SP, Brasil.
Arq Neuropsiquiatr. 2019 Sep 5;77(8):568-573. doi: 10.1590/0004-282X20190087.
Motor impairments in stroke survivors are prevalent and contribute to dependence in daily activities, pain and overall disability, which can further upper-limb disability. Treatment with botulinum toxin A (BoNT-A) is indicated for focal spasticity and requires knowledge of biomechanics and anatomy to best select muscles to be injected in the limb. OBJECTIVE We aimed to describe the frequency of posture patterns in a Brazilian sample of stroke survivors and correlate them with recommendations of muscle selection for treatment with BoNT-A. METHODS Fifty stroke patients with spastic upper limbs scheduled for neuromuscular block were photographed and physically examined, to be classified by three independent evaluators according to Hefter's classification. Muscles that were injected with BoNT-A by their routine doctors were retrieved from medical charts. RESULTS Pattern III and IV were the most common (64.7%, 21.6%). We further subclassified pattern III according to the rotation of the shoulder, which effectively interfered in muscle choice. The muscles most frequently treated were shoulder adductors and internal rotators, elbow flexors and extensors, in forearm, the pronator teres and finger and wrist flexors, and, in the hand the adductor pollicis. CONCLUSION Frequencies of upper-limb postures differed from previous reports. Other clinical features, besides spasticity, interfered with muscle choice for BoNT-A injection, which only partially followed the recommendations in the literature.
中风幸存者的运动障碍很普遍，会导致日常生活依赖、疼痛和整体残疾，进而加重上肢残疾。A型肉毒毒素（BoNT-A）治疗适用于局灶性痉挛，需要了解生物力学和解剖学知识，以便最佳地选择上肢要注射的肌肉。目的我们旨在描述巴西中风幸存者样本中的姿势模式频率，并将其与BoNT-A治疗的肌肉选择建议相关联。方法对50例计划进行神经肌肉阻滞的上肢痉挛中风患者进行拍照和体格检查，由三名独立评估者根据赫夫特分类法进行分类。从病历中检索由其常规医生注射BoNT-A的肌肉。结果模式III和IV最为常见（分别为64.7%、21.6%）。我们根据肩部旋转对模式III进一步细分，这有效地影响了肌肉选择。最常治疗的肌肉是肩部内收肌和内旋肌、肘部屈肌和伸肌、前臂的旋前圆肌以及手指和手腕屈肌，手部的拇收肌。结论上肢姿势频率与先前报告不同。除痉挛外，其他临床特征也会影响BoNT-A注射的肌肉选择，而这仅部分遵循文献中的建议。
