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題名 | Selective Cervical Dorsal Rhizotomy to Relieve Upper-limb Spasticity after Stroke or Spinal Cord Injury--Report of Five Cases=選擇性頸背根神經切斷治療腦中風或脊髓損傷後上肢緊繃--五病例分析 |
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作者姓名(中文) | 辛裕隆; 哈鐵木爾; 郭博昭; 蘇泉發; 林欣榮; | 書刊名 | 慈濟醫學 |
卷期 | 16:6 2004.12[民93.12] |
頁次 | 頁371-375 |
分類號 | 416.29 |
關鍵詞 | 背根切除; 神經切斷; 中風; 脊髓損傷; 緊繃; Dorsal root section; Rhizotomy; Spasticity; Spinal cord injury; Stroke; |
語文 | 英文(English) |
中文摘要 | 目的:中樞神經受損後上神經元症狀是常見的嚴重後遺症。在失去上神經元的調控之下,病患會表現反射亢進、肢體緊繃、甚至會有緊繃縮痛、刺痛等肢體症狀。這些症狀比肢體感覺麻木更造成病患的困擾。依照國際modified Ashworth scale(MAS)對肢體緊繃的評分標準,我們能建立一個客觀的評定系統對腦中風或脊髓損傷的病患來評分。低度肢體緊繃(MAS 1, 1+2分)的病患藉由口服藥物,物理或職能治療便能控制他們的不適。然而對於少數高度肢體緊繃的病患(MAS 3或4分),積極性的輔助治療,比如手術,才能幫助他們。材料與方法:我們自2001年起建立了肢體緊繃評估團隊,並應用選擇性頸背根神經切斷來治療那些腦中風或脊髓損傷後高度肢體緊繃的病患。在2001年1月到2003年12月之間,我們應用此種手術治療了5位病患的8隻上肢高度緊繃。其中2位是腦中風病患併有單側上肢症狀,3位是脊髓損傷病患併有雙側上肢障礙。術前評估時完全的無力癱瘓或高度的頸椎狹窄是排除性的重點。在這8隻上肢緊繃個案的手術中,我們採用頸後方術式切除頸椎椎板。打開髓膜後,藉由顯微手術技巧分離出預先計劃的背根神經。在手術中,我們會施行神經刺激術確認所要的背根神經。在上臂緊繃的情形,我們作C-5,C-6背根神經50%-80%的切斷。在前臂及手部緊繃的情形,我們作C-7,C-8及T-1背根神經50%-80%的切斷。結果:在三個月的追蹤與術前作比較之中,我們使用Wilcoxon sign-rank test統計法可見到平均降低上肢緊繃MAS2.5分。結論:在我們追蹤的病患之中,初步的報告顯示了選擇性頸背根切斷可以有效的治療腦中風或脊髓損傷後上肢緊繃的病情。 |
英文摘要 | Objective: Myelopathy is the most serious sequela after central nervous system insult. Due to loss of inhibition from upper neurons, hyperreflexia, spasticity, cramping pain, and paresthesia are typically noted with numbness over the limbs. Severity of spasticity is measured with the modified Ashworth scale (MAS). For patients with low-grade spasticity (MAS 1, 1+, and 2), oral medication, physical therapy, and occupational therapy can provide satisfactory results. However, for patients with high-grade spasticity (MAS 3 and 4), adjuvant therapies, such as selective dorsal rhizotomy, are needed. Materials and Methods: Since 2001, we have used selective cervical dorsal rhizotomy in Taiwan for eight spastic upper limbs in five patients. A posterior approach to the spinal canal is made under general anesthesia. After opening the dura, the selected roots are identified with anatomic landmarks and confirmed with intraoperative nerve-rot stimulation. Two dorsal roots (C-5, C-6) are selected for spasticity of the upper arm, whereas C-7, C-8, and T-1 are selected for spasticity of the forearm and hand. A 50% to 80% mechanical section is performed one by one for each root. Results: At the 3 month follow-up, reduction of mean MAS grade from 3.5 to 1+ was demonstrated (p=0.008). Spasticity of both elbow and wrist joints was reduced by C-7, C-8 and T-1 dorsal rhizotomy. Conclusions: In our experience with a limited number of patients, selective cervical dorsal rhizotomy relieves upper-limb spasticity after central nervous system insults such as stoke or spinal cord injury. |
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