選擇性背根切除術對於脊髓損傷併嚴重下肢痙攣之治療效果：病例報告

痙攣(spasticity)爲上運動神經元損傷的表現之一，輕微的痙攣可代償肌肉的無力、幫助轉位、站立、以及一些日常生活功能的執行，但嚴重的痙攣則會影響擺位、動作表現、產生褥瘡、及疼痛不適感。痙攣治療包含了物理治療、副木、口服藥物、局部肉毒桿菌素注射(botulinum toxin)、局部神經阻斷、脊髓內輸注幫浦(intrathecal baclofen pump)、及選擇性背根切除術(selective dorsal rhizotomy)。選擇性背根切除術爲針對腰椎第二節至薦椎第二節左右各六條之背神經根，利用神經電學檢查篩選出引發下肢痙攣的神經束，再予以切除，並配合術後積極復健，達到放鬆肌肉及功能進步的效果。選擇性背根切除在治療痙攣型腦性麻痺患者的治療，已有充份的文獻支持，唯在脊髓損傷的患者卻少有相關的研究及統計。本案例爲一頸椎不完全性脊髓損傷合併嚴重下肢痙攣及關節攣縮的68歲患者，在接受選擇性背根切除術及下肢內收肌及膝屈曲肌鬆弛術後，由終日臥床、日常生活完全仰賴他人的狀況，進而得以坐輪椅、練習站立、使用懸吊系統練習行走、梳頭髮、刷牙、打電話、及使用雙手承杯碗進食。由本案例可見隨著手術技術及監測儀器的進步，選擇性背根切除術已成爲安全性高的治療方式，未來可望可以繼續造福更多脊髓損傷合併嚴重下肢痙攣的患者。

關鍵字

選擇性背根切除術；痙攣；脊髓損傷

並列摘要

Spasticity refers to a velocity-dependent resistance to passive motion which was characterized as a symptom of upper motor neuron lesion. Though mild spasticity can help patients compensate for muscle weakness which is benefit for transferring and some daily living function, severe spasticity may cause difficulty in positioning, motor performance and predispose to pressure ulcer. The treatment option for spasticity includes physical therapy (positioning, stretching, range of motion exercise), splinting, oral medication (baclofen and diazepam are most commonly used), botulinum toxin or phenal block for focal spasticity, and more invasively, intrathecal baclofen pump (ITB) and selective dorsal rhizotomy (SDR). Selective dorsal rhizotomy was performed with partial resection of the dorsal roots from L2-S2 after neurophysiological interpretation and electrical stimulation. Intensive post-operation physical therapy was recommended for better therapeutic effect. The evidence of therapeutic effect on patients of spastic diplegic cerebral palsy was well documented but lacked of that for patients with spinal cord injury. This case is a 68 y/o male patient with spinal cord injury, C4 level, AIS-C. He suffered from severe spasticity complicated with bilateral lower limbs contracture. Previously he was in bed-ridden status with totally dependent daily living, besides, there was a pressure sore over sacrum. He underwent selective dorsal rhizotomy, hip adductor and hamstring release, and posterior obturator neurectomy with intensive post-operative rehabilitation. two months later, he turned out to be able to sit on a wheelchair with some ability to put on the brake, stand with support and ambulate with partial weight suspension. In addition, he could comb his hair, brush teeth, make a phone call, and feed with utensil cuff by himself. As the operative technique and intra-operative monitoring has become more and more mature, SDR may provide another safe and effective treatment option for severe spasticity of spinal cord injury.

並列關鍵字

selective dorsal rhizotomy ； spasticity ； spinal cord injury

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選擇性背根切除術對於脊髓損傷併嚴重下肢痙攣之治療效果：病例報告

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