Li Yunzhu, Sun Yixin, Lan Xinze, Wu Tingting, Xiao Yiding, Xia Zenan, Wang Hayson Chenyu, Yu Nanze, Wang Xiaojun, Long Xiao
From the Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences.
Department of Plastic and Burns Surgery, West China Hospital, Sichuan University.
Plast Reconstr Surg. 2024 Oct 1;154(4):656e-665e. doi: 10.1097/PRS.0000000000010652. Epub 2023 May 15.
Although the efficacy of botulinum toxin type A (BoNTA) has been shown to vary depending on injection layer, reconstitution volume, and BoNTA formulation, the effect of injection pattern has rarely been mentioned. The authors compared the therapeutic effects in patients treated with BoNTA with retrograde linear and traditional spot injection techniques.
Twenty-eight participants were enrolled in a split-face, patient-blinded randomized clinical trial. Each patient received BoNTA injected with linear injection technique on one side and with spot injection technique on the other side. Outcomes included wrinkle improvement rates (WIRs) of the 2 injection techniques determined by wrinkle scores derived from an Antera 3-dimensional camera, muscle activity assessed by ultrasound, and patient-reported pain rating on a numeric rating scale.
All participants completed the study. For forehead wrinkles, WIR on the linear side was significantly larger than that on the spot side at 1 week and 1 month ( P < 0.02). For glabellar wrinkles, WIR on the linear injection side was significantly larger than that on the spot side at 1 week ( P = 0.04). However, for periorbital wrinkles, WIR on the spot side was significantly larger than that on the linear side at 1 week ( P < 0.03). No significant difference was observed between the injection patterns in terms of muscle contraction and numeric rating scale pain scores.
Compared with the traditional spot injection, retrograde linear injection was superior in reducing forehead lines and glabellar lines, but less effective in reducing periorbital lines when identical dosages were injected.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
尽管已表明A型肉毒毒素（BoNTA）的疗效因注射层次、复溶体积和BoNTA制剂而异，但注射方式的影响却鲜有提及。作者比较了采用逆行线性注射技术和传统点状注射技术接受BoNTA治疗的患者的治疗效果。
28名参与者纳入一项半脸、患者盲法随机临床试验。每位患者一侧接受线性注射技术注射BoNTA，另一侧接受点状注射技术注射。结果包括通过Antera三维相机得出的皱纹评分确定的两种注射技术的皱纹改善率（WIRs）、通过超声评估的肌肉活动以及患者数字评分量表报告的疼痛评级。
所有参与者均完成研究。对于额部皱纹，线性注射侧的WIR在1周和1个月时显著大于点状注射侧（P<0.02）。对于眉间皱纹，线性注射侧的WIR在1周时显著大于点状注射侧（P = 0.04）。然而，对于眶周皱纹，点状注射侧的WIR在1周时显著大于线性注射侧（P<0.03）。在肌肉收缩和数字评分量表疼痛评分方面，两种注射方式之间未观察到显著差异。
与传统点状注射相比，在注射相同剂量时，逆行线性注射在减少额纹和眉间纹方面更优，但在减少眶周纹方面效果较差。
临床问题/证据水平：治疗性，II级。
