Palmer D T, Horn L J, Harmon R L
Department of Physical Medicine and Rehabilitation, Medical College of Ohio, Toledo 43614-5807, USA.
Am J Phys Med Rehabil. 1998 Jul-Aug;77(4):348-50. doi: 10.1097/00002060-199807000-00020.
Botulinum toxin A has been used to treat wrist and finger spasticity mainly through injection of the forearm flexor muscles. This case study describes its first reported use in managing spastic lumbricals of the hand. A 19-year-old male had significant flexion deformity and hypertonicity of the left wrist and hand, particularly the second through fifth metacarpophalangeal joints, after traumatic brain injury. By using the 0-4 Ashworth scale, spasticity of the lumbricals across the second to fourth metacarpophalangeal joints was rated 2, with persistent clonus of the finger flexors as confirmed by electromyography to the middle and ring fingers, even after botulinum toxin A injection of the flexor digitorum sublimis and profundus muscles. By using the electromyography-guided technique, botulinum toxin A was injected into the first lumbrical of the index finger (12 units), second and third lumbricals of the middle and ring fingers, respectively (15 units each), and fourth lumbrical of the little finger (10 units). At follow-up, clinical and electromyographic examination revealed a significant reduction in tone and clonus of the injected lumbricals. Ashworth scores of the lumbricals from the index to little finger improved to 1. Botulinum toxin A injection of the lumbricals can be beneficial in managing spasticity of these muscles. It is well tolerated and effective at doses of 10 to 15 units. Lumbrical injection of botulinum toxin A is a useful adjunct in our percutaneous armamentarium for managing the spastic hand.
肉毒杆菌毒素A已主要通过注射前臂屈肌来治疗手腕和手指痉挛。本病例研究描述了其首次报道用于治疗手部痉挛性蚓状肌的情况。一名19岁男性在创伤性脑损伤后出现左腕和手部明显的屈曲畸形和张力亢进，尤其是第二至第五掌指关节。使用0 - 4级Ashworth量表，第二至第四掌指关节处蚓状肌的痉挛程度评定为2级，即使在注射肉毒杆菌毒素A到指浅屈肌和指深屈肌后，经肌电图证实，中指和环指的手指屈肌仍有持续性阵挛。通过肌电图引导技术，将肉毒杆菌毒素A注射到示指的第一蚓状肌（12单位）、中指和环指的第二和第三蚓状肌（各15单位）以及小指的第四蚓状肌（10单位）。随访时，临床和肌电图检查显示注射的蚓状肌张力和阵挛明显减轻。示指至小指蚓状肌的Ashworth评分改善至1级。注射肉毒杆菌毒素A到蚓状肌对治疗这些肌肉的痉挛可能有益。其耐受性良好，10至15单位的剂量有效。在我们经皮治疗手部痉挛的方法中，向蚓状肌注射肉毒杆菌毒素A是一种有用的辅助手段。
