應用超音波導引注射類固醇及肉毒桿菌素治療外傷性蹠骨截肢合併馬蹄足內翻變形之病歷報告

本病例為外傷性截肢的病患。在常規的復健治療下還是有出現髖關節攣縮及踝關節馬蹄足內翻而需使用輔助器步行。經骨科醫師轉介後先以肌電圖排除腓神經性損傷後，並以超音波導引下注射類固醇於髂腰肌並在踝關節前室抽吸積水，另外將類固醇注射於足後跟滑囊及脛後肌肌腱低迴音病灶。注射後踝關節蹠曲角度從30度變為20度，髖關節屈曲角度從15度變0度，兩天後施予肉毒桿菌治療注射於左側腓腸肌內外肌，比目魚肌，脛後肌，屈趾短肌。注射後踝關節回到中立位置，接受復健訓練後病患可自行獨立行走。

關鍵字

應用超音波導引注射（echo guide injection）；外傷性截肢（traumaticjoint amputation）；肉毒桿菌素治療（botulinum toxin type A injection）；足踝攣縮（ankle contracture）

並列摘要

In this report we share 21 year-old young man with traumatic transmetatarsal amputation treated with multiple operations after few weeks of surgery. Foot equinovarus deformity was noted which leads to walking disability and affects daily activities. Patient was referred to us from orthopedic doctor because he hesitated to have another operation for Achilles tendon lengthening. During the physical examination, equinovarus foot with hip contracture were observed which may be caused by muscle imbalance or nerve injury. Nerve conduction velocity and electromyography tests (NCV/EMG) was arranged for differentiating between neurogenic contraction and myogenic contracture. Peroneal nerve injury was ruled outafter the NCV/EMG examination, sonography was used to check for the presence of muscle lesions. Hip joint tapping with echo-guided local injection of steroids was performed for hip flexion contracture. Hip joint flexion contracture was improved from 15 degree to 0degree. And the left ankle ultrasound examination revealed effusion over anterior recesses, thickening of retrocalcaneal bursa and hypoechoic changes over tibialis posterior tendon. Afterecho-guided ankle joint tapping with steroid injection, ankle plantar contracture was improved from 30 degree to 20 degree. And then we calculated the required dose of botulinum toxin A (BTA) and injected it into the left gastrocnemius lateral/medial head, soleus, tibialis posterior muscle, flexor digitorum brevis muscleusing sonographic guidance. An ankle could return to its neutral position. After 3 weeks of ambulation training with supra malleolar orthosis he could walk independently. In summary, combined use of echo-guided injection of steroid and BTA, ankle contracture can be restored.

並列關鍵字

echo guide injection ； traumatic join amputation ； botulinum toxin type A injection ； ankle contracture

國際替代計量

應用超音波導引注射類固醇及肉毒桿菌素治療外傷性蹠骨截肢合併馬蹄足內翻變形之病歷報告

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