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脊髓刺激和鞘内泵输注管理在残疾运动员中的应用:一项回顾性病例系列研究

Spinal Cord Stimulation and Intrathecal Pump Infusion Management in Para-Athletes: A Retrospective Case Series.

作者信息

Fawaz Rayan, De Laurentis Camilla, Thomas Audrey, Curtet Muriel, Giner Anne-Marie, Duraffourg Manon

机构信息

Service de Neurochirurgie Fonctionnelle, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, Bron, France.

出版信息

Am J Phys Med Rehabil. 2025 Aug 1;104(8):743-747. doi: 10.1097/PHM.0000000000002761. Epub 2025 Apr 16.

Abstract

OBJECTIVES

To present our experience with 4 para-athletes implanted with intrathecal baclofen pump and spinal cord stimulation, detailing their management and the potential complications these patients may face.

DESIGN

For spinal cord stimulation, data collected included stimulation level, surgical complications, and pain scale assessment before the procedure and at 3-mo follow-up. For intrathecal baclofen, data collected included catheter level, surgical complications, baclofen concentration and dosage, and Modified Ashworth Scale.

RESULTS

The sports practiced by the patients include sitting volleyball, shooting, handcycling, and table tennis. Concerning patients implanted with spinal cord stimulation, the first patient showed benefits on her phantom limb pain allowing her to resume training while the second patient presented an electrode fracture. Patients receiving intrathecal baclofen improved their spasticity. One of the patients required only a continuous infusion, while the other needed a bolus infusion adapted to training hours.

CONCLUSIONS

The use of spinal cord stimulation and intrathecal baclofen in para-sports is not contraindicated. Only the use of intrathecal morphine requires a therapeutic use exemption. Spinal cord stimulation and intrathecal baclofen require special monitoring, considering the needs of para-athletes and the particularities of the sport they practice. Further studies will be needed to assess the sporting performance of patients implanted with spinal cord stimulation or intrathecal infusion pumps.

摘要

目的

介绍我们为4名植入鞘内巴氯芬泵和脊髓刺激器的残疾运动员治疗的经验,详细说明对他们的管理以及这些患者可能面临的潜在并发症。

设计

对于脊髓刺激,收集的数据包括刺激水平、手术并发症以及术前和3个月随访时的疼痛量表评估。对于鞘内巴氯芬,收集的数据包括导管位置、手术并发症、巴氯芬浓度和剂量以及改良Ashworth量表。

结果

患者从事的运动包括坐式排球、射击、手摇车运动和乒乓球。对于植入脊髓刺激器的患者,第一名患者的幻肢痛得到缓解,得以恢复训练,而第二名患者出现电极断裂。接受鞘内巴氯芬治疗的患者痉挛症状有所改善。其中一名患者仅需持续输注,而另一名患者则需要根据训练时间进行推注。

结论

在残疾运动员中使用脊髓刺激和鞘内巴氯芬并无禁忌。仅鞘内注射吗啡需要治疗用途豁免。考虑到残疾运动员的需求及其从事运动的特殊性,脊髓刺激和鞘内巴氯芬需要特殊监测。需要进一步研究来评估植入脊髓刺激器或鞘内输注泵患者的运动表现。

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