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分值均分别高于治疗前的(49.5±7.9)分,并且差异均有统计学意义(CSS分值:t=-11.632、-26.432、-32.111,GMFM分值:t=9.091、14.159、17.352;均为P<0.001);治疗1个月时,对照组患儿CSS及GMFM分值与治疗前比较,差异均无统计学意义(P>0.05);治疗3、6个月时,对照组患儿CSS分值分别低于治疗前的(12.0±1.6)分,GMFM分值分别高于治疗前的(48.5±8.5)分,并且差异均有统计学意义(CSS分值:t=-18.247、-17.109,GMFM分值:t=10.366、11.723;均为P<0.001)。结论在常规粗大运动功能训练及中医推拿治疗基础上,联合基于肌内神经分布的针刺疗法,治疗痉挛性CP尖足畸形患儿起效更早,能进一步缓解肢体痉挛、减轻下肢尖足异常程度、提高下肢运动能力。
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 of1,3,6 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.Results(1)There were no significant differences between two groups of children in gender constituent ratio of male and female,age,and grade constituent ratio of gradeⅡandⅢ of gross motor function grading system(GMFCS)(P>0.05).(2)Comparison results of CSS and GMFM scores between two groups:there were no significant differences between two groups in CSS and GMFM scores before treatment(P>0.05).The CSS scores at 1,3,6 months after treatment in observation group were(10.5±1.9)sores,(7.6±1.7)sores and(7.0±1.5)sores,respectively,which were lower than those of(11.9±1.7)sores,(8.6±1.6)sores and(8.2±1.8)sores,respectively in control group;the GMFM scores at 1,3,6 months after treatment in observation group were(66.7±9.5)sores,(79.6±10.1)sores and(90.2±10.9)sores,respectively,which were higher than those of(49.1±8.8)sores,(73.1±11.2)sores and(81.5±12.6)sores,respectively in control group,and the differences were all statistically significant(CSS score:t=-2.662,P=0.011;t=-2.022,P=0.049;t=-2.374,P=0.022.GMFM score:t=6.588,P<0.001;t=2.086,P=0.043;t=2.532,P=0.015).(3)Comparison results of CSS and GMFM scores of intra group:the CSS scores at 1,3,6 months after treatment were lower than that of before treatment′s(12.1±1.7)scores,respectively,the GMFM scores were higher than that of before treatment′s(49.5±7.9)scores,respectively in observation group,and the differences were statistically significant(t=-11.632,-26.432,-32.111;t=9.091,14.159,17.352;all P<0.001).There were no significant differences in CSS and GMFM scores between 1 months after treatment and before treatment in control group(P>0.05).The CSS scores at 3,6 months after treatment were lower than that of before treatment′s(12.0±1.6)scores,respectively,while the GMFM scores were higher than that of before treatment′s(48.5±8.5)scores,respectively in control group,and the differences were statistically significant(t=-18.247,-17.109;t=10.366,11.723;all P<0.001).Conclusions Through the basis of routine rehabilitation exercise training of gross motor function and massage therapy of traditional Chinese medicine,and combined with acupuncture therapy based on intramuscular nerve distribution,those treatment strategies for spastic CP tip foot deformity took effect earlier,which can further alleviate limbs spasm,alleviate abnormal posture of lower limb toes and improve motor function of lower limbs.
引文
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