酚劑肌內神經阻斷術於處理肌肉痙攣之成效

Phenol Intramuscular Neurolysis in the Management of Spasticity

楊翠芬(Tsui-Fen Yang) ； 徐道昌(Tao-Chung Hsu)

《中華民國復健醫學會雜誌》 19期 (1991/12) Pp. 45-51

https://doi.org/10.6315/JRMA.199112.0045

摘要

上運動神經元病變在臨床上常會造成不等程度的用肌肉痙攣，當痙攣程度嚴重時，會影響到病人的運動功能或造成照料上的因難，日後發生肌肉骨骼系統併發症的機會也因而提高。本研究共收集了41位臨床上共有中度至重度肌肉痙攣的患者，男性28位，女性13位，年齡由2至72歲不等，其中腦性麻痺佔34例，腦血管病變佔5例，頭部外傷佔2例。選擇性的在其影響運動功能及日常照料之痙攣肌肉群，施以酚劑肌內神經阻斷術(Phenol Intramuscular Neurolysis)。除9例因合作性太差，需上全身麻醉施打外，其餘部份患者則使用鎮靜肛劑來提高合作度，以求注射之準確性。總共注射之肌肉149條，包括腓腸肌時（Gastronemius)54條，髖內收股(Hip Adductor)50條，膕內收側腱肌（Medial Hamstring）28條，肱二頭肌（Biceps)6條，肱三頭肌（Triceps）1條，屈腕肌及屈指肌（Wrist and Finger Flexors)8條，脛後肌(Posterior Tibialis)2條。除注射前後定期評估關節活動度、肌肉痙攣程度、深部肌腱反射及踝陣攣（Ankle Clonus），以追蹤藥效持續時間外，並探討患者日常運動功能在注射後有無明顯改變。追蹤期間由1個月至7個月不等，藥效持續時間平均為6個月，關節活動度之增加則可維持更久，其中至少打三分之一的患者在追蹤期間功能上有明顯改善。有四例因合併嚴重肌肉肌腱短縮，在注射後仍需接受骨科矯正手術。3位患者注射後局部右輕微腫脹發生，6位患者主訴注射那位疼痛，上述症狀均在注射後1至2天內消失。149條肌肉內有6條肌肉在注射後一星期左右出現局部疼痛及小硬塊，在經局部熱療及藥物等保守性療法後，症狀均於二至三週內緩解。此外，並無其他嚴重之副作用發生。

關鍵字

酚劑肌內神經阻斷術 ； 肌肉痙攣

並列摘要

In patients with upper motor neuron dieases. they usually present with variable degrees of spasticity. Moderate and severe degree of spasticity will interfere with patients' function and cause great difficulty in daily care. The incidence of musculoskeletal deformity which requires surgical correction is also higher in patients with severe spasticity. There were 43 patients with upper motor neuron diseases, which included 34 patients with cerebral palsy. 5 patients with cerebrovascular diseases and 2 patients with head injury. Phenol intramuscular neurolysis were performed in the muscle groups with moderate to severe spasticity that interferes with function and daily care in these patients. 149 muscles were injected, included 57 gastronemius. 50 hip adductors. 28 medial hamstrings. 6 biceps, 1 triceps, 8 wrist and finger flexors and 2 posterior tibials. For more accurate localization of the muscles to be injected, we used general anesthesia or chloral hydrate PR in patients with cerebral palsy. To evaluate effect and duration of phenol intramuscular neurolysis. preblock and post-block periodically assessment of range of motion of joints, degree of spasticty, deep tendon reflex and ankle clonus were done in each patients. Also. any side effect after block or improvement in motor function were investigated. The follow-up period ranged from 1 to 7 months. The duration of effect is 6 months on the average. The improvement in ROM of Joints has lassted even longer. One third of patients showed improvement in motor function. Four patients still needed orthopedic surgery after block due to coincidence with joints contracture. Three and six patients complained of local swelling and tenderness within 2 days after block respectively. 6 muscles developed local induration and tenderness 1 week after block. Their symptoms subsided 2 to 3 weeks after conservative management. No systemic side effects were noted in our study.