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

doi:10.3969/j.issn.1006-9771.2025.04.013

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (4): 476-483.doi: 10.3969/j.issn.1006-9771.2025.04.013

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

朱海丰¹^,², 钱桂凤¹^,², 丹禹钦³, 高静纯¹^,², 唐婷婷¹^,², 霍明⁴, 谢韶东¹^,²()

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

收稿日期:2025-01-17 修回日期:2025-02-05 出版日期:2025-04-25 发布日期:2025-04-25
通讯作者: 谢韶东(1968-)，男，主任中医师，主要研究方向：骨科运动创伤康复。E-mail: 1152735687@qq.com
作者简介:朱海丰(1977-)，男，汉族，广东梅州市人，副主任医师，主要研究方向：肌骨康复。
基金资助:
1.国家自然科学基金面上项目(82372585);2.广东省中医药局科研项目(20211365);广东省中医药局科研项目(20223017);3.佛山市自筹经费类科技创新项目(2220001005567)

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

ZHU Haifeng¹^,², QIAN Guifeng¹^,², DAN Yuqin³, GAO Jingchun¹^,², TANG Tingting¹^,², HUO Ming⁴, XIE Shaodong¹^,²()

1. Foshan Traditional Chinese Medicine Hospital, Foshan, Guangdong 528000, China
2. The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong 528000, China
3. Rehabilitation Medicine College of Shandong University of Traditional Chinese Medicine, Ji'nan, Shandong 250355, China
4. University of Health and Rehabilitation Sciences, Qingdao, Shandong 266113, China

Received:2025-01-17 Revised:2025-02-05 Published:2025-04-25 Online:2025-04-25
Contact: XIE Shaodong, E-mail: 1152735687@qq.com
Supported by:
National Natural Science Foundation of China (General)(82372585);Guangdong Provincial Administration of Traditional Chinese Medicine Research Projects(20211365);Guangdong Provincial Administration of Traditional Chinese Medicine Research Projects(20223017);Foshan Self-funded Science and Technology Innovation Project(2220001005567)

摘要/Abstract

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。

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

Abstract:

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 ultrasound-guided 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.

Key words: sacral plexus injury, ultrasound-guided sacral canal injection, Neurotropin, rehabilitation

中图分类号:

R687.3

朱海丰, 钱桂凤, 丹禹钦, 高静纯, 唐婷婷, 霍明, 谢韶东. 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[J]. 《中国康复理论与实践》, 2025, 31(4): 476-483.

ZHU Haifeng, QIAN Guifeng, DAN Yuqin, GAO Jingchun, TANG Tingting, HUO Ming, XIE Shaodong. Ultrasound-guided sacral canal injection of Neurotropin and comprehensive rehabilitation for the aftermath of severe sacral plexus injury: a case report[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(4): 476-483.

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神经	刺激/记录电极	神经传导速度/(m·s^-1)		潜伏期/ms		诱发动作电位振幅/mV
神经	刺激/记录电极	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
胫神经	踝/拇展肌	41.1	44.3	4.7	3.5	14.1	16.9
腓总神经	腘窝/拇展肌	40.3	46.2	13.4	11.7	12.0	13.3
腓浅神经	踝/趾短伸肌	46.5	52.3	3.7	3.5	11.4	11.7

肌肉	自发电位正锐波		主动电位峰值/mV
肌肉	治疗前	治疗后	治疗前	治疗后
右臀大肌	+	3-	3.26	4.18
右股外侧肌	3-	3-	3.53	4.01
右腓肠肌	3+	2+	0.10	1.49

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

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评定方法	治疗前	治疗4周	治疗10周	随访	评定方法	治疗前	治疗4周	治疗10周	随访
AIS分级	D级	E级	E级	E级	MMT
FGA评分	6	23	30	30	左下肢	4级	5级	5级	5级
MBI评分	55	85	100	100	右下肢	3级	4级	5级	5级
吃饭	10	10	10	10	SF-36
洗澡	5	5	5	5	生理功能	20	65	90	95
修饰	5	5	5	5	生理职能	0	25	100	100
穿衣	5	10	10	10	躯体疼痛	22	74	90	84
大便控制	5	10	10	10	一般健康状况	40	67	70	65
小便控制	5	10	10	10	精力	35	75	100	100
如厕	5	5	10	10	社会功能	44	44	89	89
转移	5	10	15	15	情感职能	0	67	100	100
步行	5	10	15	15	精神健康	60	80	96	96
上下楼	5	10	10	10	健康变化	0	75	100	100

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