A型肉毒毒素不同注射方式治疗单纯性咬肌肥大患者的疗效及对咬肌厚度的影响

摘要 目的：探讨A型肉毒毒素不同注射方式治疗单纯性咬肌肥大患者的疗效及对咬肌厚度的影响。方法：选择2014年6月-2016年6月在我院接受治疗的单纯性咬肌肥大患者84例，根据随机数字表法将患者均分为研究组和对照组，两组各42例，其中对照组进行单次注射A型肉毒毒素，研究组给予连续注射A型肉毒毒素。所有患者在治疗前、治疗后1个月、治疗后3个月、治疗后6个月、治疗后9个月、治疗后12个月，采用超声对进行咬肌厚度进行检测；在治疗后12个月调查两组患者对治疗效果的主观评价，同时邀请两名专家对患者的治疗效果进行评价。记录患者在治疗后出现的不良反应。结果：研究组在治疗后9个月、治疗后12个月的咬肌厚度显著低于对照组，差异有统计学意义（P<0.05），对照组患者的咬肌厚度在治疗后1个月至治疗后6个月逐渐降低，治疗后6个月达到最低值，在治疗后9个月和治疗后12个月开始回升。研究组患者的咬肌厚度在治疗后一直呈下降的趋势，并在治疗后12个月达到最低值。两组治疗后的各个时间点的咬肌厚度均低于治疗前，差异有统计学意义（P<0.05）。研究组患者本人的主观评价和专家评价为A、B、C的比例均显著低于对照组，D、E的比例均显著高于对照组，差异有统计学意义（P<0.05）。两组患者不良反应发生情况无统计学差异（P>0.05）。结论：与单次注射相比，A型肉毒毒素连续注射能更好的降低咬肌厚度，同时患者对治疗效果的主观评价和专家的评价较好，且不良反应少，临床上治疗咬肌肥大时可选用连续注射A型肉毒毒素的方式。

Curative Effect of Different Botulinum Toxin Type A Injection Methods on Patients with Simple Masseter Muscle Hypertrophy and Their Effects on Masseter Muscle Thickness

ABSTRACT Objective: To investigate the efficacy of different botulinum toxin type A injection methods in the treatment of simple masseter muscle hypertrophy and their influence on the masseter muscle thickness. Methods: 84 cases of simple masseteric hypertrophy patients who were treatment in our hospital from June 2014 to June 2016 were selected and were divided into study group and control group according to the random table method, with 42 cases in each group. The control group was given single time injection of botulinum toxin type A, while the study group was given continuous injection of botulinum A toxin. Before treatment and 1 month after treatment, 3 months after treatment, 6 months after treatment, 9 months after treatment, 12 months after treatment, ultrasound was used to detect the masseter muscle thickness of all the patients. 12 months after treatment, the subjective evaluation on curative effect of patients in the two groups were investigated, and two experts were invited to evaluate the curative effect at the same time. The adverse reactions of the pa- tients after treatment were recorded. Results: The masseter muscle thickness of the patients in study group 9 months and 12 months after treatment were significantly lower than the control group, the differences were statistically significant (P<0.05). The masseter muscle thickness in the control group decreased gradually from 1 months after treatment to 6 months after treatment, and reached the minimum at 6 months after treatment, and began to rise from 9 months to 12 months after treatment. The masseter muscle thickness of the patients in the study group decreased after treatment and reached a minimum at 12 months after treatment. The masseter muscle thickness at each time point after treatment in the two groups was lower than before treatment, the difference was statistically significant (P<0.05). The proportion of A, B, C of the subjective evaluation and expert evaluation of the patients in the study group were significantly lower than those of the control group, while the proportion of D and E of those were significantly higher than those of the control group, the differ- ences were statistically significant (P<0.05). There was no significant difference in adverse reactions between the two groups (P>0.05). Conclusion: Compared with single injection, continuous injection of botulinum toxin type A can better reduce masseter muscle thickness, and the subjective evaluation and expert evaluation of the therapeutic effect are better, and the side effects are less. The botulinum toxin type A can be used continuously in the treatment of hypertrophy of masseter muscle.