ACCURACY OF BOTULINUM TOXIN TYPE A INJECTION INTO THE FOREARM MUSCLES OF CHRONIC STROKE PATIENTS WITH SPASTIC FLEXED WRIST AND CLENCHED FIST: MANUAL NEEDLE PLACEMENT EVALUATED USING ULTRASONOGRAPHY
ACCURACY OF BOTULINUM TOXIN TYPE A INJECTION INTO THE FOREARM MUSCLES OF CHRONIC STROKE PATIENTS WITH SPASTIC FLEXED WRIST AND CLENCHED FIST: MANUAL NEEDLE PLACEMENT EVALUATED USING ULTRASONOGRAPHY
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DOI：
10.2340/16501977-1871
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发表时间：
2014-11-01
影响因子：
3.5
通讯作者：
Smania, Nicola
中科院分区：
文献类型：
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作者：
Picelli, Alessandro;Roncari, Laura;Smania, Nicola
目的：探讨A型肉毒毒素前臂肌肉注射的准确性。设计：前瞻性临床研究。患者：41例慢性卒中患者，计划将A型肉毒毒素注射到前臂肌肉：腕屈肌、尺侧屈腕肌、指浅屈肌和指深屈肌。方法：根据Huber&Heck关于应用肉毒杆菌毒素治疗痉挛的建议，通过触诊和解剖标志对要注射的肌肉进行表面识别。结果：超声评价手法置针的总准确率为51.2%。手指屈肌的准确率显著高于腕屈肌(63.4%比39.0%)。手指屈肌厚度明显大于腕屈肌(平均1.58vs0.49 cm)。结论：对于手腕痉挛、拳头紧握的慢性卒中患者，在前臂肌肉注射A型肉毒毒素时，应使用器械引导，以达到可接受的置针精度。
Objective: To investigate the accuracy of manual needle placement for injection of botulinum toxin type A into the forearm muscles of adults with spastic flexed wrist and clenched fist as a consequence of stroke.Design: Prospective clinical study.Patients: A total of 41 adults with chronic stroke who were scheduled to receive botulinum toxin type A injection into the following forearm muscles: flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis and flexor digitorum profundus.Methods: According to Huber & Heck's atlas suggestions on treatment of spasticity with botulinum toxin, surface identification of muscles to inject was performed by means of palpation and anatomical landmarks. Accuracy of needle placement and muscle thickness at the site of needle insertion were assessed using ultrasonography.Results: Overall accuracy of manual needle placement evaluated using ultrasonography was 51.2%. Accuracy was significantly higher for the finger flexors than for the wrist flexors (63.4% vs 39.0%). The finger flexors were significantly thicker than the wrist flexors (mean 1.58 vs 0.49 cm).Conclusion: Instrumental guidance should be used in order to achieve an acceptable accuracy of needle placement when performing botulinum toxin type A injections into the fore-arm muscles of chronic stroke patients with spastic flexed wrist and clenched fist.