A型肉毒毒素局部注射对远隔部位F波影响的临床研究_0.docVIP

A型肉毒毒素局部注射对远隔部位F波影响的临床研究 【关键词】 ,A型肉毒毒素；痉挛性斜颈；远隔效应；,F波；,运动神经元 [摘要] 目的 观察A型肉毒毒素局部注射后远隔部位F波改变，揭示对脊髓运动神经元兴奋性的 影响 ，探讨机制。 方法 选取29例原发性痉挛性斜颈患者， 应用 A型肉毒毒素进行颈部肌肉注射 治疗 ，检测和比较注射前、注射后1周和12～16周尺神经及胫神经F波的潜伏期及出现率。 结果 痉挛性斜颈患者A型肉毒毒素局部注射后1周及12～16周，尺神经及胫神经M波波幅、潜伏期和神经传导速度与注射前无显著差异；局部注射后1周，尺神经及胫神经F波潜伏期较注射前显著延长（P0.05），出现率无显著差异；注射后12～16周，尺神经及胫神经F波潜伏期及出现率与注射前无显著差异；胫神经和尺神经F波潜伏期变化值（注射前后差值）没有显著差异，与A型肉毒毒素注射剂量无明显相关性。 结论 A型肉毒毒素局部注射存在”远隔效应”， 远隔部位F波潜伏期显著延长，脊髓运动神经元兴奋性显著降低，注射部位距离及剂量不起决定作用，其发生机制复杂，可能多因素参与。 [关键词] A型肉毒毒素；痉挛性斜颈；远隔效应； F波；运动神经元 [Abstract] Objective To evaluate the remote F-wave and excitability of the spinal motoneurons changes after local intramuscular administration of botulinum toxin type A. Methods Botulinum toxin type A was injected into neck muscles of 29 patients with idiopathic torticollis spasmodicus. The latency and persistence of F- waves of the ulnar nerve and the tibial nerve were recorded bilaterally and compared immediately before （time 0） and 1 and 12～16 weeks after the injections. Results The amplitude， the latency and conductive velocity of the M-waves of the ulnar nerves and the tibial nerves were unchanged at times 1 week and 12～16 weeks after BTX-A injection. The latency of the F-waves of the ulnar nerves and the tibial nerves were prolonged significantly at times 1 week（P0.05） and recovered 12～16 weeks after BTX-A injection. The persistence of the F-waves were unchanged at times 1 week and 12～16 weeks after BTX-A injection. No significant correlation of the change of latency was found with the spreading distance and the used dosage of BTX-A. Conclusion It proposes the remote effects after local BTX-A application. The remote F-wave latency is prolonged and the excitability of remote spinal motoneurons is decreased after local BTX-A application. No significant correlation of the changes of F-wave was found with the used dosage and spreading distance of BTX-A. Possibly， its pathophysiological mechanism is very complex， and many causes are involved. [Key words] b