Chen S S, Chien C H, Yu H S
Department of Neurology, Kaohsiung Medical College, Taiwan.
Acta Neurol Scand. 1988 Sep;78(3):167-76. doi: 10.1111/j.1600-0404.1988.tb03640.x.
One hundred and fifteen cases of injection myopathy with deltoid and/or gluteal fibrotic contracture were studied, almost all of whom had definite histories of repeated intra-gluteal or intra-deltoid injections. One third had siblings affected by the same fibro-muscular disorders manifested by focal muscle atrophy and limitation of adduction and flexion of the shoulder or hip. Electromyography disclosed myopathic changes of the fibrotic muscles. Muscle biopsy showed marked perimysial and endomysial fibrosis with non-specific degeneration, regenerative changes and, in some cases, partial denervation signs. Under the electron microscope, endomysial and perimysial collagen fibrils lost their normal unimodal diameter distribution and showed a rather broad spectral distribution of diameters suggesting a defective control of collagen formation in this disease entity. Repeated injection injuries and myotoxicity resulting in multifocal myositis are the first trigger of this fibrotic syndrome, and abnormal control of collagen formation could be another important pathogenic factor.
对115例伴有三角肌和/或臀肌纤维化挛缩的注射性肌病患者进行了研究，几乎所有患者都有明确的反复臀内或三角肌内注射史。三分之一患者的兄弟姐妹患有同样的纤维肌肉疾病，表现为局部肌肉萎缩以及肩部或髋部内收和屈曲受限。肌电图显示纤维化肌肉存在肌病性改变。肌肉活检显示肌束膜和肌内膜明显纤维化，伴有非特异性变性、再生性改变，在某些情况下还有部分失神经征象。在电子显微镜下，肌内膜和肌束膜胶原纤维失去了正常的单峰直径分布，显示出相当宽的直径谱分布，提示在这种疾病中胶原形成的控制存在缺陷。反复注射损伤和导致多灶性肌炎的肌毒性是这种纤维化综合征的首要触发因素，而胶原形成的异常控制可能是另一个重要的致病因素。
