A型肉毒毒素注射后咬肌形态与肌力改变的非侵入性监测  

Noninvasive monitoring of changes in the structure and function of masseter muscles after the injection of botulinum toxin type A

作　　者：郭好[1] 刁雪红[2] 夏文[3] 刘天一[1] 陈悦[2] 郑洁皎[3] 周轶群[1] 杨平[1] 朱晶晶[1] 

机构地区：[1]上海复旦大学附属华东医院整形美容科,200040 [2]上海复旦大学附属华东医院超声科,200040 [3]上海复旦大学附属华东医院康复科,200040

出　　处：《中华整形外科杂志》2016年第6期437-440,共4页Chinese Journal of Plastic Surgery

基　　金：上海市卫生计生委员会青年科研项目（20124Y150）;上海市卫生系统优秀学科带头人培养计划资助项目（XBR2011033）

摘　　要：目的 利用非侵入性手段动态监测A型肉毒毒素注射后双侧咬肌形态及肌力变化,客观评价治疗效果和时效性.方法 随机选取良性咬肌肥大的女性患者20例,年龄22 - 43岁,平均（31.5±5.6）岁,采用A型肉毒毒素对称注射.应用高频超声和皮肤表面肌电图检测咬肌在松弛状态和用力咬合状态下的厚度、硬度以及肌力变化,记录注射前及注射后l、4、12、24周的各项指标数据,进行综合评价.患者和医师分别对治疗效果进行主观评价,并与之前所测数据结果进行比较.结果 A型肉毒毒素注射咬肌后l周,肌肉的厚度、硬度及肌力开始出现降低,12周时降至最低值,松弛状态咬肌的厚度和硬度平均降低18％ - 39％和20％-32％,咬合状态的咬肌肌力减少78％,注射后24周各项指标基本达注射前水平.医、患主观评价均为在注射后12周时瘦脸效果最明显,与高频超声和肌电图检测结果相一致.结论 高频超声和皮肤表面肌电图可作为客观评价A型肉毒毒素注射咬肌疗效的有效手段.Objective To evaluate the effect and maintaining period of botulinum toxin A on the masseter muscles through noninvasive monitoring of changes in the structure and function of masseter muscle.Methods We randomly selected 20 female patients with benign masseter hypertrophy,22-43 years old,who were treated with injection of botulinum toxin A.High-frequency ultrasound was adopted to measure thickness and hardness of muscles.Surface electromyography （sEMG） was used to observe the changes of muscle force.All patients were followed up before and 1,4,12 and 24 weeks after the injection of botulinum toxin type A.Subjective evaluation of the efficacy was performed by questionnaire survey.Results The thickness and hardness of muscle decreased 1 week after injection which attained the lowest level at 12 weeks.The thickness and hardness reduced by 18%-39% and 20%-32% respectively at relaxed state of masseter muscles,the muscle force reduced by 78% during muscle contraction.The muscle recovered to previous state 24 weeks after injection.The subjective evaluation by doctor and patients was consistent with the results by the high frequency ultrasound and EMG detection results.Conclusions High frequency ultrasound and surface electromyography are effective and noninvasive means for objective evaluation of masseter muscles after the injection of botulinum toxin type A.

关 键 词：肉毒毒素 咬肌 超声 肌电图 

分 类 号：R745.12[医药卫生—神经病学与精神病学]