Limb immobilization for the treatment of focal occupational dystonia
Limb immobilization for the treatment of focal occupational dystonia
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肢体固定治疗局灶性职业性肌张力障碍
DOI：
10.1212/wnl.57.3.405
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发表时间：
2001
期刊：
影响因子：
9.9
通讯作者：
S. Barbieri
中科院分区：
文献类型：
--
作者：
A. Priori;A. Pesenti;A. Cappellari;G. Scarlato;S. Barbieri
背景：职业性局灶性上肢肌张力障碍的特征是不自主的肌肉收缩，选择性地干扰特定运动任务的执行，如写作或演奏乐器。职业性牙痛有严重的社会影响，特别是在某些职业中。现有的医疗方法收效甚微。方法：对8例特发性上肢职业性局灶性肌张力障碍患者，用塑料夹板固定前臂和手部，平均(±SD)4.5±0.75周。在夹板固定前(基线)和夹板后不同时间(4、12、24周)对肌张力障碍的严重程度和患者的运动功能进行客观评估(手臂肌张力障碍评定量表和Tubiana和Chamagne评分)和主观评估(自评分数)。结果：摘除夹板4周后，患者恢复正常自主活动时，肌张力障碍的严重程度和患者运动任务受损的表现均有改善；术后随访疗效无明显变化(上肢肌张力障碍评分：基线20.6±30.2%；4周后83.9±23.8%，P=0.007；12周后83.9±23.8%，P=0.007；24周后79.7±29.5%，P=0.015)。Tubiana和Chamagne评分：基线28.6±22.7%；4周后80.0±23.1%，p=0.015；12周后80.0±23.1%，p=0.015；24周后74.3±32.1%，p=0.031。自评分数：基线20.6±19.3%；4周后63.7±25.2%，p=0.015；12周后66.9±28.1%，p=0.015；24周后70.6±31.8%，p=0.015)。在24周的访问中，1名患者的改善消失，3名患者为中度，4名患者明显改善。结论：肢体固定术是治疗局限性职业性上肢肌张力障碍的一种简单、有效、安全、廉价的治疗方法。
Background: Occupational focal upper-limb dystonia is characterized by involuntary muscle contractions that selectively interfere with the execution of specific motor tasks such as writing or playing a musical instrument. Occupational dystonias have a severe social impact, especially in certain professions. The available medical treatments offer little benefit. Methods: In eight patients with idiopathic occupational focal dystonia of the upper limb, the dystonic forearm and hand were immobilized with a plastic splint for mean (±SD) 4.5 ± 0.75 weeks. Before splinting (base line) and at various intervals afterwards (4, 12, and 24 weeks), the authors assessed the severity of dystonia and the patients’ motor performance objectively (Arm Dystonia Disability Scale and Tubiana and Chamagne Score) and subjectively (Self-Rating Score). Results: Assessment 4 weeks after splint removal, when patients had regained normal voluntary movements, showed that the severity of dystonia and the patients’ performance of the impaired motor task had improved; the benefit persisted unchanged at later follow-up visits (Arm Dystonia Disability Scale: base line 20.6 ± 30.2%; after 4 weeks 83.9 ± 23.8%, p = 0.007; after 12 weeks 83.9 ± 23.8%, p = 0.007; after 24 weeks 79.7 ± 29.5%, p = 0.015. Tubiana and Chamagne Score: base line 28.6 ± 22.7%; after 4 weeks 80.0 ± 23.1%, p = 0.015; after 12 weeks 80.0 ± 23.1%, p = 0.015; after 24 weeks 74.3 ± 32.1%, p = 0.031. Self-Rating Score: base line 20.6 ± 19.3%; after 4 weeks 63.7 ± 25.2%, p = 0.015; after 12 weeks 66.9 ± 28.1%, p = 0.015; after 24 weeks 70.6 ± 31.8%, p = 0.015). At the 24-week visit the improvement disappeared in one patient, was moderate in three, and marked in four. Conclusions: Limb immobilization can be a simple, effective, safe, and inexpensive treatment for focal occupational upper-limb dystonia.