- 期刊
- OpenAccess
Injection-induced Multifocal Fibrous Muscular Contractures: A Case Report
肌肉注射導致多發性纖維化肌肉孿縮：病例報告
摘要
在此報告一個因長期肌肉注射而導致肌肉纖維化病變，合併嚴重翼狀肌、肱三頭肌和臀肌攣縮的病例。一位五十二歲家庭主婦因兩側髖關節疼痛，於私人診所接受肩部和臀部肌肉注射多年。住院時發現在她的右側肩關節外展孿縮和右側肘關節伸展攣縮極為嚴重，影響日常生活甚巨。其肩關節X光素片發現肩關節外展攣縮、肱骨頭向下半脫位、肩胛骨外緣向下向前旋轉變形、肩峰往側邊下移、以及局部軟組織骨化。大腿的X光素片亦發現軟組織有小的骨化點。磁振造影證實於兩側翼狀肌、右側肱三頭肌、兩側臀肌及股四方肌內有肌肉纖維化攣縮的特徵，亦即在各種脈衝影像中有低訊號強度之纖維化索狀物在肌肉內。我們將右側翼狀肌及肱三頭肌上的索狀物執行鬆跚手術，並將盂肱關節執行關節固定手術。於術後一年追蹤，病人的右側肩關節及肘關節有足夠的活動範圍，不妨礙日常的活動。 文獻上有關纖維化肌肉攣縮的報告很少，多刊登在骨科的文獻，影像檢查更是鳳毛麟角。多半的病例報告為局部病變，且都有肌肉注射的病史。磁振造影不僅在手術前可確定診斷，且可評估病灶的嚴重程度，以決定手術的方式。本病例無論就其多發性、嚴重性、以及完整的影像檢查，都是極為罕見或絕無僅有。
並列摘要
A case of injection myopathy with severe deltoid, triceps and gluteal contractures was reported. The patient was a 52-year-old female housewife who had received intramuscular injections in shoulders and buttocks for years in private clinics because of hip pain. At admission, she complained of abduction contracture of right shoulder, measuring 100 degrees, and extension contracture of right elbow, measuring 180 degrees, which caused severe disability in daily activity. Routine radiographs of right shoulder showed severe abduction contracture of right humerus, inferior subluxation of humeral head mimicking luxatio erecta, antero-inferior rotation of lateral scapular border, and lateral down-sloping of acromial process. Radiographs of arms and thighs disclosed small calcifications and ossifications in the soft tissue. MRI demonstrated characteristic muscular fibrous contractures in bilateral deltoid muscles, right triceps brachii, bilateral gluteus and vastus lateralis muscles manifesting intramuscular hypointense fibrotic cords on all pulse sequences and resultant contractures of both shoulders. Release of fibrotic bands of right deltoid, triceps muscles and arthrodesis of right glenohumeral joint were performed. In the follow-up one year later, the patient had achieved an adequate enough range of motion of right shoulder and elbow despite mild residual deformity. Fibrous muscular contracture are rarely reported. Only a few cases of multifocal contractures resulting from injection myopathy have been reported in orthopedic journals. MRI can make the specific diagnosis, evaluate the extent and size of the lesion for surgical consideration while excluding the possibility of other diseases. To our knowledge, this the first case reported of injection- induced multifocal fibrous muscular contractures with complete imaging studies.