基于肌内神经分布针刺联合常规康复训练治疗痉挛性脑性瘫痪尖足畸形  

Acupuncture therapy based on intramuscular nerve distribution combined with routine rehabilitation exercise training for the treatment of spastic cerebral palsy with tip foot deformity

作　　者：向俊璐 刘圆圆 魏巍 李岚 王东[2] 周文智 Xiang Junlu;Liu Yuanyuan;Wei Wei;Li Lan;Wang Dong;Zhou Wenzhi(Department of Rehabilitation,Chengdu Women′s and Children′s Central Hospital,Chengdu 610000,Sichuan Province,China;Department of Rehabilitation Medicine,Affiliated Hospital of Chengdu University,Chengdu 610081,Sichuan Province,China)

机构地区：[1]成都市妇女儿童中心医院康复科,610000 [2]成都大学附属医院康复医学科,610081

出　　处：《中华妇幼临床医学杂志（电子版）》2018年第6期698-703,共6页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：四川省教育厅一般项目(16ZB0432);成都市卫生计生委医学科研课题(2015070)~~

摘　　要：目的探讨基于肌内神经分布的针刺疗法联合常规康复训练,对痉挛性脑性瘫痪(CP)尖足畸形患儿的痉挛程度及粗大运动功能的疗效。方法选择2013年7月至2016年11月,于成都市妇女儿童中心医院康复科进行治疗的47例痉挛性CP尖足畸形患儿为研究对象。采用随机数字表法,将其分为观察组(n=24)和对照组(n=23)。2组患儿均给予相同的常规粗大运动训练及中医推拿治疗,观察组患儿则在此基础上,另给予基于肌内神经分布的针刺治疗,所有患儿均共计治疗6个月。分别于治疗前及治疗1、3、6个月时,采用《综合痉挛量表(CSS)》及《粗大运动功能测试量表(GMFM)》,对2组患儿进行疗效评价。对2组患儿的一般临床资料,以及2组患儿治疗前、后不同时间点疗效评价结果组间及组内进行比较,采用t检验及χ~2检验进行统计学分析。本研究遵循的程序符合成都市妇女儿童中心医院伦理委员会制定的伦理学标准,并获得该伦理委员会批准[审批文号:2015(11)号],所有患儿监护人均签署临床研究知情同意书。结果 (1)2组患儿性别构成比,年龄及粗大运动功能分级系统(GMFCS)分级(Ⅱ级、Ⅲ级)构成比比较,差异均无统计学意义(P>0.05)。(2)CSS及GMFM分值组间比较:治疗前,2组患儿CSS及GMFM分值比较,差异均无统计学意义(P>0.05)。治疗1、3、6个月时,观察组患儿CSS分值分别为(10.5±1.9)分、(7.6±1.7)分、(7.0±1.5)分,均低于对照组的(11.9±1.7)分、(8.6±1.6)分、(8.2±1.8)分;而GMFM分值分别为(66.7±9.5)分、(79.6±10.1)分、(90.2±10.9)分,均高于对照组的(49.1±8.8)分、(73.1±11.2)分、(81.5±12.6)分,并且上述差异均有统计学意义(CSS分值:t=-2.662,P=0.011;t=-2.022,P=0.049;t=-2.374,P=0.022;GMFM分值:t=6.588,P<0.001;t=2.086,P=0.043;t=2.532,P=0.015)。(3)CSS及GMFM分值组内比较:治疗1、3、6个月时,观察组患儿CSS分值均分别低于治疗前的(12.1±1.7)分,GMFM分值均分别高�Objective To study the clinical efficacy of the degree of spasm and gross motor function of acupuncture therapy based on intramuscular nerve distribution combined with routine rehabilitation exercise training for treatment of tip foot deformity in children with spastic cerebral palsy(CP).Methods From July 2013 to November 2016,a total of 47 children with spastic CP tip foot deformity who were treated in the Department of Rehabilitation,Chengdu Women′s and Children′s Central Hospital,were selected as research subjects.Using random number table method,they were divided into observation group(n=24)and control group(n=23).Both groups were treated by the same routine rehabilitation exercise training and traditional Chinese medicine massage,meanwhile the observation group were taken additional acupuncture therapy based on intramuscular nerve distribution,and all the children were treated for 6 months.Before treatment,and after treatment of 1,3,6 months,curative effect of CP children were evaluate by the Gross Motor Function Measure Scale(GMFM)and Composite Spasticity Scale(CSS).The general clinical data between two groups of children,also the evaluation results of curative effect at different time points before and after treatment between two groups and intra group were compared by t test and chi-square test for statistical analysis.The procedure followed in this study were in lined with the ethical standards formulated by the Ethics Committee of Chengdu Women′s and Children′s Central Hospital,and has been approved by this committee[approval number:2015(11)].All guardians of children signed the informed consents of clinical research.Results①There were no significant differences between two groups of children in gender constituent ratio of male and female,age,and grade constituent ratio of gradeⅡandⅢof gross motor function grading system(GMFCS)(P>0.05).②Comparison results of CSS and GMFM scores between two groups:there were no significant differences between two groups in CSS and GMFM scores before treat

关 键 词：脑性瘫痪 肌痉挛状态 马蹄足畸形 针刺疗法 腓神经 胫神经 儿童 

分 类 号：R742.3[医药卫生—神经病学与精神病学]