因為手術中姿勢不良所導致肌筋膜疼痛症候群之病例報告

Myofascial Pain Syndrome induced by Malpositioning during Surgery-- A Case Report

肌筋膜疼痛症候群應為手術過程中因姿勢不當所造成之術後上肢疼痛和功能異常之重點考慮因素之一。鮮少有人能夠把因為臂叢神經受侷限而導致肌筋膜疼痛與臂叢神經受傷的病例清楚地分辨出來。我們在此報告一四十四歲病例，本身罹患有僵直性脊椎炎導致頸部活動不便，因為膽結石併發急性膽囊發炎而於本院接受膽囊切除術。病患術前並未有任何手麻或是運動障礙之症狀。麻醉誘導過程順利，且無插管困難以及頸椎移動之情況；整個手術過程平順，而且在病患清醒並能自主呼吸之情況下拔除其氣管內管。不幸地，病患於術後主訴有左手臂疼痛和運動功能障礙的症狀產生。在安排了頸部核磁共振攝影和肌電圖的檢查後，發現有明顯的頸椎前凸以及左側手臂肌皮神經之病灶。而在對病患實施詳細的神經學檢查後，我們發現病患之臂叢神經似乎被縮短的胸小肌所壓迫侷限，而導致肌筋膜疼痛症候群的症狀。我們此時於病患受到壓迫侷限的胸小肌之激痛點上利用針灸用之長針施予乾針去活化刺激，並且輔助以熱敷、肌肉牽引、與止痛劑服用，病患手臂無力和疼痛的症狀便能逐漸獲得緩解改善。因此，我們相信肌筋膜疼痛症候群是造成這位病患左手臂疼痛和運動功能障礙等症狀的主要原因。

It is a real challenge to the anesthesiologists to differentiate brachial plexus injury (BPI) from myofascial pain syndrome (MPS). The possibility of MPS should be suspected in a patient with complaints of pain and dysfunction of the upper arm immediately after surgery. Here we report a case of gallstone with cervical ankylosing spondylitis who sustained myofascial pain syndrome (MPS) immediately after open cholecystectomy. We utilized dry needle stimulation to deactivate the trigger point of the pectoris minor muscle and stretching the muscle to relieve the muscle pain after the diagnosis was made. The patient completely recovered 2 weeks later.