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題 名 | Catheter Migration after Implantation of an Intrathecal Baclofen Infusion Pump for Severe Spasticity: A Case Report=治療嚴重肌肉痙攣之脊膜內Baclofen注射幫浦術後併發導管移位--病例報告 |
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作 者 | 李棟州; 陳美秀; 黃金山; 陳俊賢; 劉元凱; 陳敏弘; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷 期 | 24:9 2008.09[民97.09] |
頁 次 | 頁492-497 |
分類號 | 416.292 |
關鍵詞 | 注射幫浦; 脊膜內; 肌肉痙攣; 脊椎損傷; Baclofen戒斷症候群; Baclofen; Infusion pump; Intrathecal; Spasticity; Spinal cord injury; Baclofen withdrawal syndrome; |
語 文 | 英文(English) |
中文摘要 | 我們報告一例脊膜內 baclofen 注射幫浦植入後併發導管移位的病案。在本病案中,55 歲男性病患在頸部脊髓損傷合併四肢不完全癱瘓四年後,因嚴重的軀體與四肢痙攣及僵直而接受脊膜內 baclofen 注射幫浦植入手術。在首次脊膜內注射幫浦植入手術 12 個月後,病患又復發軀體緊繃與肌肉痙攣的症狀。以顯影劑注射於幫浦之側孔後,以 X 光及電腦斷層照影檢查發現有顯影劑聚積於腰椎皮下區域,顯示導管系統移位進入背部皮下區。因此,病患接受導管系統的重新置放手術。於重新置放導管之手術中,我們特別注意避免留置於脊椎外的導管過長,並且以一個直角之導管固定器將導管固定於脊椎上筋膜 (supraspinous fascia)。此外,導管之固定亦盡量使固定器至導管進入脊椎上筋膜的距離縮短以避免因病人彎腰活動時導管外滑。病患於導管重新置換後獲得肌肉痙攣僵直的改善,且於手術一年後的追蹤中接受每天 150 微克脊膜內 baclofen 注射可獲得病情之穩定控制。因此,在本報告中,我們強調在裝置脊膜內注射幫浦手術中幾項應注意的技術以固定幫浦的導管並防止導管移位及其相關之併發症。 |
英文摘要 | We report a case of intrathecal baclofen infusion pump implantation complicated by migration of the catheter tip. A 55-year-old man required an intrathecal baclofen infusion for severe spasticity 4 years after a cervical spinal cord injury with incomplete tetraparesis. Twelve months after initial implantation of the device, the patient began to experience a recurrence of trunk tightness and spasticity. Subsequent X-ray and computed tomography evaluations of the catheter system revealed pooling of contrast medium outside of the intrathecal distribution in the lumbar subcutaneous region of the back and therefore migration of the pump catheter tip. At surgical revision, emphasis was placed on minimizing the length of catheter outside of the spine and securing the catheter in the supraspinous fascia with a right-angled anchor. The distance between the anchors and the entry point of the catheter into the supraspinous fascia was also reduced to prevent slipping when the patient bends forward. After surgery, the patients spasticity improved and, 1 year later, he has experienced no further complications during follow-up, requiring an average baclofen dose of 150 microg/day. Here, we describe several surgical methods intended to secure the intrathecal catheter and prevent catheter migration. Other complications related to catheter failure are also highlighted. |
本系統中英文摘要資訊取自各篇刊載內容。