Karri Jay, Mas Manuel F, Francisco Gerard E, Li Sheng
Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston McGovern Medical School, , USA.
J Rehabil Med. 2017 Jun 28;49(6):482-488. doi: 10.2340/16501977-2239.
To present practice patterns for phenol neurolysis procedures conducted for spasticity management.
A retrospective review of 185 persons with spasticity who underwent phenol neurolysis procedures (n = 293) at an academic rehabilitation hospital and clinic. Patient demographics, concomitant spasticity treatments, and procedure relevant information were collected.
The cohort included 71.9% males and 61.6% inpatient procedures. Neurological diagnoses included stroke (41.0%), traumatic brain injury (28.6%) and spinal cord injury (24.3%). Musculoskeletal diagnoses included spastic hemiplegia or paresis (51.3%), tetraplegia (38.4) and paraplegia (9.2%). At the time of phenol neurolysis, most patients (77.5%) received concomitant pharmacological treatments for spasticity. Injection guidance modalities included electrical stimulation and ultrasound (69.3%) or ultrasound only (27.3%). A mean of 3.48 ml of phenol were injected per nerve and 10.95 ml of phenol were used per procedure. Most commonly injected nerves included the obturator nerve (35.8%) and sciatic branches to the hamstrings and adductor magnus (27.0%). Post-phenol neurolysis assessment was recorded in 54.9% of encounters, in which 84.5% reported subjective benefit. Post-procedure adverse events included pain (4.0%), swelling and inflammation (2.7%), dysaesthesia (0.7%) and hypotension (0.7%).
Phenol neurolysis is currently used to reduce spasticity for various functional goals, including preventing contractures and improving gait. Depending on the pattern of spasticity displayed, numerous peripheral nerves in the upper and lower extremities can be targeted for treatment with phenol neurolysis. Further research into its role in spasticity management, including studies exploring its cost-effectiveness and pharmacological and side-effects compared with other treatment options are needed.
介绍用于痉挛管理的酚神经溶解术的实践模式。
对在一家学术康复医院和诊所接受酚神经溶解术（n = 293）的185例痉挛患者进行回顾性研究。收集患者人口统计学资料、伴随的痉挛治疗方法以及与手术相关的信息。
该队列中男性占71.9%，住院手术占61.6%。神经学诊断包括中风（41.0%）、创伤性脑损伤（28.6%）和脊髓损伤（24.3%）。肌肉骨骼诊断包括痉挛性偏瘫或轻瘫（51.3%）、四肢瘫（38.4%）和截瘫（9.2%）。在进行酚神经溶解术时，大多数患者（77.5%）同时接受了痉挛的药物治疗。注射引导方式包括电刺激和超声（69.3%）或仅超声（27.3%）。每条神经平均注射3.48毫升酚，每次手术使用10.95毫升酚。最常注射的神经包括闭孔神经（35.8%）以及坐骨神经至腘绳肌和大收肌的分支（27.0%）。54.9%的病例记录了酚神经溶解术后的评估，其中84.5%报告有主观改善。术后不良事件包括疼痛（4.0%）、肿胀和炎症（2.7%）、感觉异常（0.7%）和低血压（0.7%）。
目前酚神经溶解术用于降低痉挛以实现各种功能目标，包括预防挛缩和改善步态。根据所表现出的痉挛模式，上肢和下肢的许多周围神经都可作为酚神经溶解术的治疗靶点。需要进一步研究其在痉挛管理中的作用，包括探索其与其他治疗选择相比的成本效益、药理作用和副作用的研究。
