超声引导下骶管注射神经妥乐平和综合康复治疗重度骶丛神经损伤后遗症期的个案报道  

Ultrasound-guided sacral canal injection of Neurotropin and comprehensive rehabilitation for the aftermath of severe sacral plexus injury:a case report

作　　者：朱海丰 钱桂凤 丹禹钦 高静纯 唐婷婷 霍明 谢韶东[1,2] ZHU Haifeng;QIAN Guifeng;DAN Yuqin;GAO Jingchun;TANG Tingting;HUO Ming;XIE Shaodong(Foshan Traditional Chinese Medicine Hospital,Foshan,Guangdong 528000,China;The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine,Foshan,Guangdong 528000,China;Rehabilitation Medicine College of Shandong University of Traditional Chinese Medicine,Ji'nan,Shandong 250355,China;University of Health and Rehabilitation Sciences,Qingdao,Shandong 266113,China)

机构地区：[1]佛山市中医院,广东佛山市528000 [2]广州中医药大学第八临床医学院,广东佛山市528000 [3]山东中医药大学康复医学院,山东济南市250355 [4]康复大学,山东青岛市266113

出　　处：《中国康复理论与实践》2025年第4期476-483,共8页Chinese Journal of Rehabilitation Theory and Practice

基　　金：国家自然科学基金面上项目(No.82372585);广东省中医药局科研项目(No.20211365;No.20223017);佛山市自筹经费类科技创新项目(No.2220001005567)。

摘　　要：目的观察超声引导下骶管注射神经妥乐平联合综合康复对骶骨骨折引发的重度骶丛神经损伤患者的临床效果。方法报道2024年3月1例因骶骨骨折导致重度骶丛神经损伤10个月患者,采用超声引导下骶管注射神经妥乐平,并进行综合康复。采用美国脊柱损伤协会残损分级(AIS)、徒手肌力评定法、视觉模拟评分法、改良Barthel指数(MBI)、健康调查简表(SF-36)和功能性步态评价量表进行评定;采用神经传导速度测试、肌电检查和超声波探查检测患者神经传导速度和骶尾韧带结构。结果治疗4周和10周后,患者肌力、MBI评分、功能性步态评分和SF-36各项评分均升高;AIS分级由D级转为E级;视觉模拟评分降低。随访时,视觉模拟评分和SF-36中躯体疼痛和一般健康状况小幅升高。治疗10周后,神经传导速度增加、潜伏时缩短、诱发动作电位振幅升高;自发电位正锐波减少,主动电位峰值增加;右侧臀大肌、股外侧肌和腓肠肌主动电位峰值升高;骶尾韧带排列更为清晰、整齐。无不良反应。结论超声引导骶管注射结合综合康复能有效缓解重度骶丛神经损伤后遗症期患者的疼痛,提高日常生活活动能力,改善生活质量。Objective To observe the effect of ultrasound-guided sacral canal injection of Neurotropin combined with comprehensive rehabilitation on severe sacral plexus injury after sacral fracture.Methods A case with severe sacral plexus injury ten months after sacral fracture was reviewed.He accepted ultrasoundguided sacral canal injection of Neurotropin along with comprehensive rehabilitation,and was assessed with American Spinal Injury Association Impairment Scale(AIS)impairment scale,manual muscle testing,Visual Analog Scale(VAS),modified Barthel Index(MBI),Short-form of Health Survey(SF-36)and Functional Gait Assessment(FGA),and measured the nerve conduction velocity and the structural organization of the sacrococcygeal ligament using nerve conduction velocity tests,electromyography(EMG)and ultrasound examination before and after treatment.Results After four weeks and ten weeks of treatment,the muscle strength,and scores of MBI,FGA and SF-36 increased,while the ASIA score improved from grade D to grade E,and VAS score decreased.During follow-up,the VAS score and physical pain and general health status scores of the SF-36 increased.After ten weeks of treatment,nerve conduction velocity increased,latency shortened,and the amplitude of evoked action potentials increased.The presence of spontaneous sharp waves decreased,and the peak of active potentials increased.The peak of active potentials in the right gluteus maximus,vastus lateralis and gastrocnemius muscles increased.The structural organization of the sacrococcygeal ligament appeared clearer and more orderly.No adverse reaction was observed.Conclusion Ultrasound-guided sacral canal injection of Neurotropin combined with comprehensive rehabilitation is effective on pain,activities of daily living and quality of life for patients with severe sacral plexus injury during the sequelae period.

关 键 词：骶丛神经损伤 超声引导下骶管注射 神经妥乐平 康复 

分 类 号：R687.3[医药卫生—骨科学]