中医经筋手法结合运动疗法对小儿痉挛型脑瘫运动及步行能力的影响  

Effect of Meridian Sinew Manipulation Combined with Exercise Therapy on Locomotion and Walking Abilities in Children with Spastic Cerebral Palsy

作　　者：韩行普 黄超[1] 冯益民[1] 陈雨琼 刘春雷[1] HAN Xing-pu;HUANG Chao;FENG Yi-min;CHEN Yu-qiong;LIU Chun-lei(Hunan Children′s Hospital,Changsha Hunan 410004)

机构地区：[1]湖南省儿童医院,湖南长沙410004

出　　处：《世界中西医结合杂志》2023年第11期2249-2253,共5页World Journal of Integrated Traditional and Western Medicine

基　　金：2022年湖南省中医药科研计划项目(F2022012)。

摘　　要：目的观察中医经筋手法结合运动疗法对小儿痉挛型脑瘫运动及步行能力的影响。方法选取2021年1月—2022年6月期间湖南省儿童医院收治的127例痉挛型脑瘫患儿为研究对象,以单纯随机抽样法分为对照组63例和观察组64例。对照组给予常规对症治疗和运动疗法,观察组在对照组基础上联合中医经筋手法治疗。治疗3个月后,观察比较两组患儿临床疗效,治疗前后改良Ashworth痉挛量表(Modified Ashworth Scale,MAS)评分、精细运动功能评定量表(Peabody developmental motor scale,PDMS-2)评分、粗大运动功能评定量表(Gross Motor Function Measure,GMFM)评分和步行能力。结果治疗后观察组临床总有效率93.75%(60/64)高于对照组80.95%(51/63),差异有统计学意义(P<0.05)。治疗1、2、3个月后两组患儿MAS评分均较治疗前下降,差异有统计学意义(P<0.05);且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后两组患儿抓握能力、视觉运动能力评分均较治疗前升高,差异有统计学意义(P<0.05);两组患儿抓握能力、视觉运动能力评分比较,差异无统计学意义(P>0.05)。治疗后两组患儿GMFM行走和跑跳、站立位、坐位、爬与跪位、卧位与翻身评分均较治疗前升高,差异有统计学意义(P<0.05);且观察组站立位、坐位、爬与跪位评分高于对照组,差异有统计学意义(P<0.05)。治疗后两组患儿跨步长、1 min步行距离较治疗前增加,步宽、10 m步行时间较治疗前减少,差异有统计学意义(P<0.05);且观察组跨步长、1 min步行距离长于对照组,步宽、10 m步行时间短于对照组,差异有统计学意义(P<0.05)。结论中医经筋手法联合运动疗法治疗痉挛性脑瘫患儿疗效较好,有利于减轻肌张力、缓解肌肉痉挛状态,可提高粗大运动功能,具有较好的应用价值。Objective To observe the effect of meridian sinew manipulation combined with exercise therapy on the locomotion and walking abilities in children with spastic cerebral palsy.Methods A total of 127 children with spastic cerebral palsy treated in Hunan Children′s Hospital from January 2021 to June 2022 were selected and assigned into an observation group(n=64)and a control group(n=63)by simple random sampling.The control group received conventional symptomatic treatment and exercise therapy,while the observation group was treated with meridian sinew manipulation on the basis of the therapy in the control group.The clinical efficacy was compared between the two groups.The modified Ashworth scale(MAS)score,Peabody developmental motor scale-2(PDMS-2)score,gross motor function measure(GMFM)score,and walking ability were measured before and after treatment.Results The total response rate in the observation group was 93.75%(60/64),which was higher than that 80.95%(51/63)in the control group(P<0.05).After treatment for 1,2,and 3 months,the MAS score declined in the two groups and was lower in the observation group than in the control group(P<0.05).After treatment,the grasping ability and visual motor ability scores increased(P<0.05)and had no significant differences between the two groups(P>0.05).After treatment,the scores of walking,running,and jumping,standing,sitting,crawling,and lying and rolling in GMFM increased in the two groups(P<0.05).Moreover,the scores of standing,sitting,and crawling in the observation group were higher than those in the control group(P<0.05).The treatment in both group increased the stride length and 1 min walking distance and reduced the stride width and 10 m walking time(P<0.05),and the changes were more significant in the observation group than in the control group(P<0.05).Conclusion Meridian sinew manipulation combined with exercise therapy can treat the children with spastic cerebral palsy by reducing muscle tension,relieving muscle spasm,and improving gross motor function,demonstratin

关 键 词：痉挛型脑瘫 小儿 中医经筋手法 运动疗法 运动能力 步行能力 

分 类 号：R244.1[医药卫生—针灸推拿学] R742[医药卫生—中医临床基础]