痉挛性斜颈的那些事

<a class="ke-insertfile" href="/xmcgmhFile/2024/09/11/20240911135529756.docx" target="_blank">痉挛性斜颈的那些事<span><span> </span><b><span><span> </span></span></b></span></a><span> </span> <p> <b><span>一、什么是痉挛性斜颈？</span></b> </p> <span> </span> <p style="text-indent:21pt;"> <span>颈部肌张力障碍又称为痉挛性斜颈，简称斜颈（俗称歪脖子），是最常见的成年发病型局灶性肌张力障碍。表现为不同程度的颈部姿势异常、颈部震颤和<span>/</span>或颈部疼痛。通常为良性病程，但不治疗会导致严重失能，且常漏诊或误诊。</span> </p> <span> </span> <p> <b><span>二、病因是什么？</span></b> </p> <span> </span> <p style="text-indent:21pt;"> <span><span><b>特发性</b><span> </span>—<span> </span>大多数成年发病型颈部肌张力障碍为特发性。病因不明，但遗传易感性可能有重要影响。环境因素<span>(</span>如颈部创伤<span>)</span>可能诱使具有遗传易感性的个体发病</span></span> </p> <span> </span> <p style="text-indent:21pt;"> <span><span><b>遗传性</b><span> </span>—<span> </span>极少数成人局灶型肌张力障碍病例为单基因疾病。已知可导致成年发病型孤立性颈部肌张力障碍的遗传变异包括：<b><i><span>CIZ1</span>、 <span>ANO3 </span>、<span>GNAL</span>、<span>THAP1</span></i></b></span></span> </p> <span> </span> <p style="text-indent:21pt;"> <span><span><b>获得性</b><span> </span>—<span> </span>成人获得性颈部肌张力障碍主要是多巴胺受体阻断剂引起，可分为急性和迟发性</span></span> </p> <span> </span> <p> <b><span>三、发病机制是什么？</span></b> </p> <span> </span> <p style="text-indent:21pt;"> <span>通常认为颈部肌张力障碍属于基底节相关疾病。但与其他肌张力障碍一样，目前越来越倾向于认为是一种神经网络疾病，而基底节只是其中一环。</span> </p> <span> </span> <p> <span><span><b>四、有哪些临床表现</b><span> </span></span></span> </p> <span> </span> <p style="text-indent:31.5pt;"> <span>颈部肌张力障碍通常在中年发病。<span>70%-80%</span>在<span>30-60</span>岁之间。<span>30</span>岁之前发病很少见，若出现应考虑遗传性或获得性肌张力障碍</span> </p> <span> </span> <p style="text-indent:21pt;"> <span style="font-family:等线;font-size:10.5pt;">颈部姿势异常<span> </span>—是颈部肌张力障碍的诊断性特征，可见于所有患者。肌张力障碍姿势出现在清醒时，一般在睡眠时缓解，无慢性肌肉骨骼异常。根据颈部和头部位移的平面和方向来描述姿势，最常见的是转头和侧头。根据<span>col-cap</span>分型分为侧颈、侧头、转颈、转头、屈颈、屈头、伸颈、伸头、侧方移位和失状移位，如下图所示：</span><span><img width="536" height="259" 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" /></span> </p> <span> </span> <p style="text-indent:21pt;"> <span><span><b>震颤</b><span> </span>—<span> </span>约<span>70%</span>的颈部肌张力障碍患者还伴有震颤，大多累及头部</span></span> </p> <span> </span> <p style="text-indent:21pt;"> <span><span><b>疼痛</b><span> </span>—<span> </span>疼痛是颈部肌张力障碍中特别常见的表现，也是失能的主要原因</span></span> </p> <span> </span> <p style="text-indent:21pt;"> <span><span><b>感觉诡计</b><span> </span>—<span> </span>即通过触觉动作，例如触摸面部的某一特定区域改善肌张力障碍症状</span></span> </p> <span> </span> <p style="text-indent:21pt;"> <span><span><b>相关肌张力障碍综合征—<span> </span></b>大多数成人颈部肌张力障碍病例都为孤立性和散发性，极少数情况下，患者的颈部肌张力障碍可能是某种综合征的一个显著特征</span></span> </p> <span> </span> <p> <b><span>五、如何诊断</span></b> </p> <span> </span> <p style="text-indent:21pt;"> <span>颈部肌张力障碍是一种临床诊断，患者表现为成人期隐匿性起病的颈部姿势异常，常伴随疼痛和颈部震颤时应予以考虑。神经系统检查显示颈部姿势异常，并伴有肌张力障碍的典型特征<span>(</span>如，感觉诡计、头部定向性震颤<span>)</span>，即可做出诊断。</span> </p> <span> </span> <p> <b><span>六、需要做什么检查</span></b> </p> <span> </span> <p style="text-indent:21pt;"> <span>一般情况下不需要。如果临床表现不典型或神经系统检查有异常发现<span>(</span>除颈部肌张力障碍和相关的颈部<span>/</span>上肢震颤外<span>)</span>，应进行脑部和颈椎<span>MRI</span>检查。可选择性进行基因检测，主要针对复合型肌张力障碍综合征或有家族史的患者。</span> </p> <span> </span> <p> <b><span>七、如何治疗</span></b> </p> <span> </span> <p style="text-indent:21pt;"> <span><span><b>一线治疗</b>：颈部肌张力障碍的首选治疗是注射肉毒毒素<span>(botulinum toxin, BoNT)</span>。将肉毒素注射到目标颈部肌肉以引起选择性去神经支配和颈部异常姿势放松。由专业人士进行注射可明显缓解症状且几乎没有副作用。临床益处通常在注射后约<span>1</span>周才显现，注射后<span>1</span>个月时达到峰值。肉毒素疗效持续<span>3-6</span>个月，药效消失后需重复注射以获得持续益处。</span></span> </p> <span> </span> <p> <span><span> </span></span> </p> <span> </span> <p style="text-indent:21pt;"> <span><span><b>二线治疗方案</b>：如果患者选择不接受注射治疗，或使用最大可耐受剂量时缓解效果欠佳，则可尝试加用口服药物。最常用于治疗成人颈部肌张力障碍的<span>3</span>种药物按疗效从高到低依次是<span><a href="https://www.uptodate.cn/contents/zh-Hans/92727?topicRef=132652&source=see_link"><span style="color:windowtext;text-decoration:none;"><span>氯硝西泮</span></span></a></span>、<span><a href="https://www.uptodate.cn/contents/zh-Hans/92742?topicRef=132652&source=see_link"><span style="color:windowtext;text-decoration:none;"><span>苯海索</span></span></a></span>和<span><a href="https://www.uptodate.cn/contents/zh-Hans/92707?topicRef=132652&source=see_link"><span style="color:windowtext;text-decoration:none;"><span>巴氯芬</span></span></a></span>。嗜睡、疲劳和意识模糊常会限制用药剂量。联用较低剂量药物有时可以避免破坏性副作用。</span></span> </p> <span> </span> <p> <span><span><b>八、预后</b>：</span></span> </p> <span> </span> <p style="text-indent:21pt;"> <span>颈部肌张力障碍是一种慢性疾病。已报道过自行缓解但较罕见。未经治疗的颈部肌张力障碍可导致颈部骨性改变，伴活动度受限、颈神经根病、慢性疼痛和残疾。</span> </p> <span> </span> <p> <br /> </p> <span> <p> <br /> </p> <span> <p>  <span> </span> </p> <p align="center" style="text-align:center;"> <span style="font-size:14pt;">痉挛性斜颈的那些事</span> </p> <p> <span> </span> </p> </span> <p> <br /> </p> </span> <p> <br /> </p> <span> </span>