Bhat Tushar, Pande Nikhil, Shah Nilesh, Andrade Chittaranjan
Lokmanya Tilak Memorial Medical College and General Hospital, Sion, Bombay, India.
J ECT. 2007 Jun;23(2):106-8. doi: 10.1097/YCT.0b013e31805b7f10.
Although modified electroconvulsive therapy (ECT) may rarely result in musculoskeletal complications, it has also been safely administered to patients with orthopedic morbidity. There is no literature on the safety of repeated courses of ECT in patients with Harrington rod implants.
We describe a 30-year-old asthenic bipolar woman who, in 1997, had a Harrington compression assembly stabilizer fitted for spinal tuberculosis and who, between 2000 and 2004, received 3 courses of modified ECT with a total of 28 treatments. In October 2006, she experienced her index episode of mania and was treated with 7 ECTs that were modified with propofol (60 mg) and succinylcholine (0.83 mg/kg). Each ECT seizure was characterized by mild tonic-clonic movements that lasted 20 to 40 seconds. Her mania remitted uneventfully with ECT. Radiological assessment after the ECT course showed that there were no orthopedic complications.
Although our patient experienced no musculoskeletal complication despite the incomplete muscle relaxation, for maximum safety, we strongly recommend full muscle relaxation for all patients with orthopedic conditions who are treated with ECT. We also suggest that in such patients, short stimulus durations be used (to the extent possible) to minimize the duration of the tonic muscular contraction that occurs during the passage of the ECT stimulus. With these precautions, the orthopedic risks associated with well-modified ECT may be no greater or less than those associated with a fit of sneezing or coughing. Our report adds to the literature on the safety of modified ECT in patients with orthopedic conditions, such as those with Harrington rods in situ.
尽管改良电休克治疗（ECT）极少会导致肌肉骨骼并发症，但也已安全应用于有骨科疾病的患者。目前尚无关于植入哈灵顿棒的患者重复进行ECT疗程安全性的文献报道。
我们描述了一名30岁的虚弱双相情感障碍女性，她于1997年因脊柱结核安装了哈灵顿加压固定器，并在2000年至2004年间接受了3个疗程的改良ECT，共28次治疗。2006年10月，她经历了首次躁狂发作，接受了7次用丙泊酚（60毫克）和琥珀酰胆碱（0.83毫克/千克）改良的ECT治疗。每次ECT发作的特征为持续20至40秒的轻度强直阵挛运动。她的躁狂症通过ECT顺利缓解。ECT疗程后的影像学评估显示无骨科并发症。
尽管我们的患者尽管肌肉松弛不完全但未出现肌肉骨骼并发症，但为了最大程度确保安全，我们强烈建议对所有接受ECT治疗的骨科疾病患者进行完全肌肉松弛。我们还建议，对于此类患者，尽可能使用较短的刺激持续时间，以尽量缩短ECT刺激通过时发生的强直性肌肉收缩的持续时间。采取这些预防措施后，改良良好的ECT所带来的骨科风险可能不高于或低于打喷嚏或咳嗽发作所带来的风险。我们的报告为有关ECT在骨科疾病患者（如原位植入哈灵顿棒的患者）中的安全性的文献增添了内容。
