顱內硬腦膜動靜脈廔管造成脊髓病變之個案報告

A Case Report of Intracranial Dural Arteriovenous Fistula Resulting in Cervical Myelopathy

楊名廷(Ming-Ting Yang) ； 李庭蓁(Ting-Chen Lee)

《物理治療》 42卷1期 (2017/03) Pp. 12-19

https://doi.org/10.6215/FJPT.PTS1466522728

摘要

背景：顱內硬腦膜動靜脈廔管造成脊髓病變於臨床上為少見之個案。本篇個案是一位59 歲的男性，2015年10 月在工作中久蹲站立後突然感到雙下肢的麻與無力，於2015 年11 月19 日血管攝影檢查確診是顱內硬腦膜動靜脈廔管，並接受動靜脈廔管結紮術，於2015 年12 月14 日開始進行門診物理治療介入，主訴為雙下肢麻且無力，行走功能不佳。研究方法：本個案報告將藉由個案處理模式做評估及介入的呈現，同時結合「國際功能、失能和健康分類」模式分析個案現在主要行走功能上的限制。檢查及介入：理學檢查發現其雙下肢肌力普遍不足，且有感覺異常和本體感覺缺失，造成個案在平衡和行走功能的表現上受到影響。而後依據分析結果及參考相關實證設計此個案的肌力、平衡訓練，另外也經由懸吊系統及跑步機等介入改善個案的行走步態及耐力。結果：在經過3 週短期治療後，個案下肢肌力動作分數進步4 分；伯格式平衡量表進步5 分；計時起走測試進步7 秒；行走速度進步0.23 公尺／秒；巴氏量表進步25 分。不論在下肢肌力動作、平衡以及行走功能上皆有進步。結論：經由3 週的肌力、平衡訓練及懸吊系統的跑步機行走訓練，有利於改善顱內硬腦膜動靜脈廔管造成脊髓病變患者功能上的恢復。

關鍵字

硬腦膜動靜脈廔管 ； 脊髓病變 ； 個案處理模式 ； 國際功能 ； 失能和健康分類 ； 行走

並列摘要

Background: Cervical myelopathy caused by intracranial dural arteriovenous fistulas is uncommon. The case reported in this study was a 59 year-old male. The symptoms were first noted in October 2015. Sudden numbness and weakness of bilateral lower extremities were noted when standing up after squatting for a long time while working. He was diagnosed of intracranial dural arteriovenous fistula by angiography on the 19th of November, 2015 and later he underwent the surgery of ligation for the fistula. The intervention of physical therapy started on the 14th of December, 2015. The chief complaint of this case was numbness and weakness over bilateral lower extremities and difficulty with walking. Methods: In this case report, we used the client management model to assess and treat the patient. Meanwhile we also used the ICF model to analyze the main functional problems in walking limitation. Examination and intervention: According to the analysis, it was shown that muscle weakness and impairment in sensation and proprioception of bilateral lower extremities affected balance performance and walking ability of the case. We designed the treatment and exercise programs, including muscle strengthening, balance training, and walking training on the treadmill with the suspension system, based on our analysis and relevant evidence-based references. Results: After three weeks of intervention, patient's lower extremity motor score increased by 4 points, the Berg Balance Scale score increased by 5 scales. The Timed Up & Go performance decreased by 7 seconds, the walking speed increased by 0.23 m/ s, and the Barthel Index score increased by 25 points. There were significant improvements in muscle strength, balance and walking ability. Conclusions: Three weeks of muscle strengthening, balance training, and walking training on the treadmill with the suspension system could be beneficial to a patient with cervical myelopathy caused by intracranial dural arteriovenous fistulas.

並列關鍵字

Dural arteriovenous fistulas ； Myelopathy ； Client management model ； ICF model ； Walking