脊髓损伤后痉挛的治疗

概述

痉挛是肌肉过度活动的表现形式之一，当大脑与脊髓之间的通信由于脊髓损伤、其他损伤或疾病而中断时，就会出现痉挛。

痉挛有一些益处，例如帮助强健肌肉。但是，痉挛也可能加剧肌肉僵硬，引发疼痛、无法控制的肌痉挛和疲劳等问题，可能会给日常活动带来困难，例如行走、坐下和睡眠。

痉挛的治疗方法通常需要结合以下方案：

• 运动。物理和作业治疗师可辅导进行伸展、站立和锻炼活动，以助维持关节活动度并防止肌肉缩短或紧绷（挛缩）。
• 口服药物。口服某些处方药可能有助于缓解肌肉痉挛。
• 鞘内疗法。有时可以每天 24 小时将药物直接注入脊髓周围的液体中来治疗痉挛。可通过植入泵和导管系统来输送药物。

• 注射。向受影响的肌肉注射肉毒杆菌（Botox）可能会减少引起肌肉痉挛的信号。注射可暂时缓解疼痛，使患者能够运动并增强肌肉。患者需要每三个月注射一次肉毒杆菌毒素。

  向发生痉挛的肌肉附近的周围神经注射石炭酸或酒精，可缓解肌痉挛。

• 神经外科与骨科外科手术。放松紧张肌腱或破坏（消融）感觉脊髓根部运动神经的手术可停止痉挛。

目的

Spasticity management may be important in preventing pain and stiffness from getting worse after a spinal cord injury. If spasticity continues long-term without treatment, it can lead to limited movement, making it hard to function. Treatment also helps prevent pressure sores on the skin.

可能出现的情况

Spasticity management for spinal cord injury usually involves a combination of therapies that may include:

• Exercises. Physical and occupational therapy can teach you stretches, positions and exercises that may help you maintain range of motion. The therapies can help prevent muscles from tightening and shortening, known as contracture.
• Oral medicines. Certain prescribed medicines given by mouth may help reduce muscle spasticity.
• Intrathecal therapy. Sometimes spasticity may be treated with medicines administered 24 hours a day directly into the fluid surrounding the spinal cord. This type of therapy is called intrathecal therapy. The medicine is delivered by a pump and tube system that is implanted during surgery.

• Injections. OnabotulinumtoxinA (Botox) injections into affected muscles may decrease the muscle signals that cause spasticity. The injections provide short-term relief, allowing you to move and strengthen your muscles. You may need injections every three months.

  Phenol or alcohol injections into the peripheral nerve near the muscles that have spasticity may reduce muscle spasms.

• Neurosurgery and orthopedic surgery procedures. Surgical procedures to release tightened tendons or destroy the motor nerves of sensory spinal roots may stop the spasticity.

结果

Spasticity management for spinal cord injury may help improve your muscles' range of motion, reduce pain and make it easier to complete daily activities.