創傷後完整肢體發生陣發性幻肢感覺及疼痛：病例報告

Paroxysmal Phantom Limb Pain in An Intact Limb Following Trauma and Hematoma Compression of Limb Perfusion: A Case Report

幻肢感覺和疼痛可肇因於神經傳入與傳出兩大病因所致，然而確切的機轉迄今仍不很清楚。我們要報告一位女性病人因車禍撞擊導致右上臂骨折，進行手術與石膏固定，並以三角巾懸吊於胸前；但是她卻仍然感覺右上臂呈垂掛在受傷時的身體右側姿勢，且感覺劇烈疼痛，而一般之常規止痛藥（ketoralac and pethidine）無法達到理想之止痛效果。經會診，我們合併給予中樞與週邊神經作用機轉之藥物（gabapentin，morphine and dextromethrophan）治療後，完全緩解其幻肢感覺及大部分疼痛。不幸地，隔天病人的生命徵象急劇變差，同時幻肢感覺及強烈疼痛亦重新回復；經血管攝影證實右鎖骨下動脈出血及血腫隨後緊急手術修補血管裂片，術後原先第二次發生的幻肢燒灼感與疼痛也消失。文中將討論幻肢感覺可能的機轉與治療。

Mechanisms underlying phantom sensation are still a matter of dispute, both input and output patterns have been discussed. We here present a patient suffering phantom sensation and pain with an intact limb after car accident. Under consideration of central and peripheral components, medication with gabapentin, morphine and dextromethrophan effectively controlled the phantom sensation and pain. However, the patient presented a deleterious change on the pain severity following previously well controlled condition, simultaneously, a potentially second insult was highly suspected. A delay direct hematoma compression with hypoperfusion ischemic injury was proven by angiogram and managed by surgical repair of flapped subclavicle artery; the painful and burning phantom limb sensation disappeared immediately and afterwards.