针刀松解术与肌松剂药物治疗改善脊髓损伤并发肌痉挛的效果比较  

Comparison between the effects of acupotome lysis and muscle relaxant on the amelioration of complicated muscular spasm of spinal cord injury

作　　者：司同[1] 汪家琮[2] 阎增红[3] 卢虎英[1] 

机构地区：[1]中国康复研究中心北京博爱医院中医康复科,北京市100068 [2]中国康复研究中心北京博爱医院脊髓损伤康复科,北京市100068 [3]中国康复研究中心北京博爱医院北区康复病房,北京市100068

出　　处：《中国临床康复》2005年第29期32-33,共2页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:观察针刀松解术治疗脊髓损伤并发肌痉挛的作用,并与肌松剂效果做比较。方法:选择2002-01/2003-03北京博爱医院亦庄住院部脊髓损伤并发肌痉挛的住院患者,随机分为针刀组30例(颈髓损伤3例,胸髓损伤27例)和对照组20例(颈髓损伤4例、胸髓损伤16例)。针刀组在损伤平面以下脊柱两侧及肌肉、关节部位触摸寻找结节、异位骨化点、扳机点,每次选择3～6点,按针刀操作规范要求定位、消毒、进针,针刀进入皮下后寻找病变组织,根据情况行横向摆动、纵向切割、铲削等松解手法,局部组织松软后拔出针刀。术后应用一般推拿手法治疗3～5次,以利于恢复。每周手术1次,选择不同部位连续3～5次,将触摸寻找的结节、异位骨化点、扳机点等大部或全部松解完毕。末次手术1个月及6个月后统计疗效。对照组口服抗痉挛药氯苯氨丁酸,先3次/d,5mg/次口服,以后每隔7d每日增加5mg,至痉挛明显减轻时的剂量即为维持剂量。1个月及6个月后统计疗效。两组均进行常规康复训练。肌痉挛程度分级采用改良的Ashworth评分法评定。结果:50例患者均均进入结果分析。针刀组及对照组患者在治疗后6个月肌痉挛程度分级评分均较治疗后1个月改善(针刀组1,2,3,4级6个月后分别有11,8,7,4例,1个月后分别有15,9,5,1例;对照组1,2,3,4级6个月后分别有8,7,4,1例,1个月后分别有9,7,3,1例,P<0.01),两组之间治疗前后肌痉挛程度分级差异不显著(P>0.05)。结论:针刀组改善肌痉挛的程度与对照组相当,但是口服抗痉挛药服药副作用大、费用高、剂量不易掌握。针刀松解术治疗简单易行、损伤小,出血少,可以反复施术,安全无副作用,且疗效可靠,是治疗脊髓损伤并发肌痉挛的又一新途径。AIM： To observe the effect of acupotome lysis in the treatment of spinal injury complicated muscular spasm and compare with the effect of muscle relaxant. METHODS： The inpatients with spinal injury complicated muscular spasm from Yizhuang Inpatient Department of Peking Boai Hospital between January 2002 and March 2003 were selected and assigned randomly into acupotome group with 30 cases （cervical vertebra injury with 3 cases, thoracic spine injury with 27 cases） and control group with 20 cases （cervical vertebra injury with 4 cases, thoracic spine injury with 16 cases）. Patients in acupotome group were touched and searched for node, hereretopic ossification point and trigger point on the two sides of spine and around muscle, articulation below the level of injury. Three to six points were selected every time. The orientation, disinfecting, and inserting were done according to the operating criterion of acupotomology. After entering into the rind acupotome was used to find lesion tissue. The brisement method such as： horrizm oscillation, transverse cut and spade etc. was performed according to situation. When part of tissue was floppy, acupotome was extracted. The general manipulation maneuver was applied for 3-5 times post-treatment in order to make better use of recovery. One operation every week, different parts were selected lasting 3-5 times. Most or the whole of the node, hererotopic ossification point and trigger point etc. were found by touch was finished brisement. The effect was known 1 and 6 months after the last operation. Patients in control group were treated with anti-spasm drug Baclofen orally, firstly three times a day with 5 mg every time orally and later every 8 days 5 mg was added a day, till the dosage when the spasm significantly relieved, that was the maintenance dosage. The effect was known after 1 and 6 months. The conventional rehabilitation training was performed in the two groups. The grade of muscular spasm degree was evaluated by improved Ashworth Scorettl. RESULTS： T

关 键 词：脊髓损伤 肌痉挛 针刀 

分 类 号：R744[医药卫生—神经病学与精神病学]