经直肠盆底肌及坐骨神经电刺激配合蒙药熏蒸治疗颈脊髓损伤肌肉痉挛疗效分析
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摘要
目的观察经直肠盆底肌及坐骨神经电刺激配合蒙药熏蒸治疗颈脊髓损伤肌肉痉挛的临床疗效,探索脊髓损伤临床治疗的新方法。方法 2012年1月—2018年1月将65例颈脊髓损伤肌肉痉挛患者利用随机数字表法随机分成治疗组(32例)和对照组(33例),治疗组采用经直肠盆底肌及坐骨神经电刺激配合蒙药熏蒸治疗,对照组主要采用药物、物理治疗及运动疗法等其他康复治疗方法。经8周治疗后分别对治疗组和对照组进行美国脊髓损伤协会(American Spinal Injury Association,ASIA)评分、改良Ashworth评分及Barthel指数评分比较。结果治疗前,两组ASIA轻触觉、疼痛觉及左右侧关键肌肌力评分以及Barthel指数评分差异均无统计学意义(P>0.05);治疗后,两组上述评分均较治疗前改善(P<0.05)。治疗组和对照组治疗后ASIA评分中左右侧关键肌肌力项评分分别为(58.55±10.83)、(50.69±11.32)分,差异有统计学意义(P<0.05);治疗组和对照组治疗后Barthel指数总分分别为(74.22±11.53)、(68.46±9.92)分,差异有统计学意义(P<0.05)。治疗后治疗组与对照组根据改良Ashworth评分的有效率分别为84.4%和60.6%,差异有统计学意义(P<0.05)。结论经直肠盆底肌及坐骨神经电刺激配合蒙药熏蒸治疗颈脊髓损伤肌肉痉挛可以有效改善患者肌肉痉挛症状及日常生活能力,在相同的治疗时间后效果明显优于对照组。
Objective To observe the effect of Mongolian medicine fumigation combined with sciatic nerve and rectal probe electrical stimulation on muscle spasticity of spinal cord injury. Methods Between January 2012 and January2018, a total of 65 patients with muscle spasticity after spinal cord injury were randomly divided into two group: the observation group(32 cases) and the control group(33 cases). The patients in the observation group were treated with Mongolian medicine(Wu Wei Gan Lu-Decoction) fumigation combined with sciatic nerve and rectal probe electrical stimulation, while the patients in the control group were treated with medicine, physical therapy, and exercise therapy.Both two groups were treated for 8 weeks. The patients were scored with Ashworth Score, American Spinal Injury Association(ASIA) score, and Barthel Index before and after treatment. Results The pre-treatment ASIA scores(light touch sensation, pain sensation, and muscle strength) and Barthel Index of the two groups were not statistically significant(P>0.05). The post-treatment ASIA scores and Barthel Index of both groups performed significantly better than the pretreatment levels(P<0.05). The post-treatment ASIA muscle strength item was 58.55±10.83 in the observation group and50.69±11.32 in the control group(P<0.05). The post-treatment Barthel Index was 74.22±11.53 in the observation group and 68.46±9.92 in the control group(P<0.05). The effective rate in the observation group was significantly better than that in the control group(84.4% vs. 60.6%, P<0.05). Conclusion Mongolian medicine fumigation combined with sciatic nerve and rectal probe electric stimulation could improve the muscle spasticity of spinal cord injury and patients' ability of daily life effectively.
Objective To observe the effect of Mongolian medicine fumigation combined with sciatic nerve and rectal probe electrical stimulation on muscle spasticity of spinal cord injury. Methods Between January 2012 and January2018, a total of 65 patients with muscle spasticity after spinal cord injury were randomly divided into two group: the observation group(32 cases) and the control group(33 cases). The patients in the observation group were treated with Mongolian medicine(Wu Wei Gan Lu-Decoction) fumigation combined with sciatic nerve and rectal probe electrical stimulation, while the patients in the control group were treated with medicine, physical therapy, and exercise therapy.Both two groups were treated for 8 weeks. The patients were scored with Ashworth Score, American Spinal Injury Association(ASIA) score, and Barthel Index before and after treatment. Results The pre-treatment ASIA scores(light touch sensation, pain sensation, and muscle strength) and Barthel Index of the two groups were not statistically significant(P>0.05). The post-treatment ASIA scores and Barthel Index of both groups performed significantly better than the pretreatment levels(P<0.05). The post-treatment ASIA muscle strength item was 58.55±10.83 in the observation group and50.69±11.32 in the control group(P<0.05). The post-treatment Barthel Index was 74.22±11.53 in the observation group and 68.46±9.92 in the control group(P<0.05). The effective rate in the observation group was significantly better than that in the control group(84.4% vs. 60.6%, P<0.05). Conclusion Mongolian medicine fumigation combined with sciatic nerve and rectal probe electric stimulation could improve the muscle spasticity of spinal cord injury and patients' ability of daily life effectively.
引文
1 Jazayeri SB, Beygi S, Shokraneh F, et al. Incidence of traumatic spinal cord injury worldwide:a systematic review. Eur Spine J,2015,24(5):905-918.
2 Ruff CA, Wilcox JT, Fehlings MG. Cell-based transplantation strategies to promote plasticity following spinal cord injury. Exp Neurol, 2012,235(1):78-90.
3 Riemann L, Younsi A, Scherer M, et al. Transplantation of neural precursor cells attenuates chronic immune environment in cervical spinal cord injury. Front Neurol, 2018, 9(8):428.
4 McGrory BJ, Klassen RA, Chao EY, et al. Acute fractures and dislocations of the cervical spine in children and adolescents.J Bone Joint Surg Am, 1993, 75(7):988-995.
5 Dale NS, Zachary JG. Epidemiology and treatment of central cord syndrome in the United States. J Spine Surg, 2018,4(4):712-716.
6王一吉,周红俊,李建军,等.脊髓损伤神经学分类国际标准检查表最新修订及解读.中国康复理论与实践,2015, 21(8):879-882.
7廖利民,吴娟,鞠彦合,等.脊髓损伤患者泌尿系管理与临床康复指南.中国康复理论与实践,2013,19(4):301-317.
8 Walden K, Belanger LM, Biering-Sorensen F, et al. Development and validation of a computerized algorithm for International Standards for Neurological Classification of Spinal Cord Injury(ISNCSCI). Spinal Cord,2016, 54(3):197-203.
9 Uei H, Tokuhashi Y, Maseda M, et al. Clinical results of minimally invasive spine stabilization for the management of metastatic spinal tumors based on the epidural spinal cord compression scale.Biomed Res Int,2018, 8(11):2035-2041.
10 Vural M, Yalcinkaya EY, Celik EC, et al. Assessment of quality of life in relation to spasticity severity and socio-demographic and clinical factors among patients with spinal cord injury. J Spinal Cord Med,2018, 3(12):1-8.
11 Adams MM, Hicks AL. Spasticity after spinal cord injury. Spinal Cord, 2005, 43(10):577-586.
12 Mckinley WO, Jackson AB, Cardenas DD, et al. Long-term medicalcomplications after traumatic spinal cord injury:a regional model systems analysis. Arch Phys Med Rehabi, 1999, 80(11):1402-1410.
13 Roy RR, Edgerton VR. Neurobiological perspective of spasticity as occurs after a spinal cord injury. Exp Neurol, 2012, 235(1):116-122.
14 Fassler PR, Swionkowski MF, Kilroy AW, et al. Injury of the sciatic nerve associated with acetabular fracture. J Bone Joint Surg(Am),1993,75(8):1157-1166.
15 Elbasiouny SM, Moroz D, Bakr MM. Management of spasticity after spinal cord injury:current techniques and future directions.Neurorehabil Neural Repair, 2010, 24(1):23-33.
16 Gracies JM. Pathophysiology of spastic paresis. I:Paresis and soft tissue changes. Muscle Nerve, 2005, 31(5):535-551.
17 Yelnik AP, Simon O, Parratte B, et al.How to clinically assess and treat muscle overactivity in spastic paresis. J Rehabil Med, 2010,42(9):80-87.
18 Bauman W, La FM, Cirnigliaro CM, et al. Low-dose baclofen therapy raised plasma insulin-like growth factor-1 concentrations,but not into the normal range in a predictable and sustained manner in men with chronic spinal cord injury. J Spinal Cord Med,2013, 36(5):476-482.
19 Shimada Y, Sakuraba T, Matsunaga T, et al. Effects of therapeutic magnetic stimulation on acute muscle atrophy in rats after hindlimb suspension. Biomed Res, 2006, 27(1):23-27.
20 Mcintyre A, Mays R, Mehta S, et al. Examining the effectiveness of intrathecal baclofen on spasticity in individuals with chronic spinal cord injury:a systematic review. J Spinal Cord Med, 2014, 37(1):11-18.
21 Handa Y, Handa T, Ichie M, et al. Functional electrical stimulation(FES)systems for restoration of motor function of paralyzed muscles--versatile systems and a portable system. Front Med Biol Eng, 1992, 4(4):241-255.
22 Shimada Y, Sato K, Matsunaga T, et al. Closed-loop control using a stretch sensor for restoration of standing with functional electrical stimulation in complete paraplegia. Tohoku J Exp Med,2001, 193(3):221-227.
2 Ruff CA, Wilcox JT, Fehlings MG. Cell-based transplantation strategies to promote plasticity following spinal cord injury. Exp Neurol, 2012,235(1):78-90.
3 Riemann L, Younsi A, Scherer M, et al. Transplantation of neural precursor cells attenuates chronic immune environment in cervical spinal cord injury. Front Neurol, 2018, 9(8):428.
4 McGrory BJ, Klassen RA, Chao EY, et al. Acute fractures and dislocations of the cervical spine in children and adolescents.J Bone Joint Surg Am, 1993, 75(7):988-995.
5 Dale NS, Zachary JG. Epidemiology and treatment of central cord syndrome in the United States. J Spine Surg, 2018,4(4):712-716.
6王一吉,周红俊,李建军,等.脊髓损伤神经学分类国际标准检查表最新修订及解读.中国康复理论与实践,2015, 21(8):879-882.
7廖利民,吴娟,鞠彦合,等.脊髓损伤患者泌尿系管理与临床康复指南.中国康复理论与实践,2013,19(4):301-317.
8 Walden K, Belanger LM, Biering-Sorensen F, et al. Development and validation of a computerized algorithm for International Standards for Neurological Classification of Spinal Cord Injury(ISNCSCI). Spinal Cord,2016, 54(3):197-203.
9 Uei H, Tokuhashi Y, Maseda M, et al. Clinical results of minimally invasive spine stabilization for the management of metastatic spinal tumors based on the epidural spinal cord compression scale.Biomed Res Int,2018, 8(11):2035-2041.
10 Vural M, Yalcinkaya EY, Celik EC, et al. Assessment of quality of life in relation to spasticity severity and socio-demographic and clinical factors among patients with spinal cord injury. J Spinal Cord Med,2018, 3(12):1-8.
11 Adams MM, Hicks AL. Spasticity after spinal cord injury. Spinal Cord, 2005, 43(10):577-586.
12 Mckinley WO, Jackson AB, Cardenas DD, et al. Long-term medicalcomplications after traumatic spinal cord injury:a regional model systems analysis. Arch Phys Med Rehabi, 1999, 80(11):1402-1410.
13 Roy RR, Edgerton VR. Neurobiological perspective of spasticity as occurs after a spinal cord injury. Exp Neurol, 2012, 235(1):116-122.
14 Fassler PR, Swionkowski MF, Kilroy AW, et al. Injury of the sciatic nerve associated with acetabular fracture. J Bone Joint Surg(Am),1993,75(8):1157-1166.
15 Elbasiouny SM, Moroz D, Bakr MM. Management of spasticity after spinal cord injury:current techniques and future directions.Neurorehabil Neural Repair, 2010, 24(1):23-33.
16 Gracies JM. Pathophysiology of spastic paresis. I:Paresis and soft tissue changes. Muscle Nerve, 2005, 31(5):535-551.
17 Yelnik AP, Simon O, Parratte B, et al.How to clinically assess and treat muscle overactivity in spastic paresis. J Rehabil Med, 2010,42(9):80-87.
18 Bauman W, La FM, Cirnigliaro CM, et al. Low-dose baclofen therapy raised plasma insulin-like growth factor-1 concentrations,but not into the normal range in a predictable and sustained manner in men with chronic spinal cord injury. J Spinal Cord Med,2013, 36(5):476-482.
19 Shimada Y, Sakuraba T, Matsunaga T, et al. Effects of therapeutic magnetic stimulation on acute muscle atrophy in rats after hindlimb suspension. Biomed Res, 2006, 27(1):23-27.
20 Mcintyre A, Mays R, Mehta S, et al. Examining the effectiveness of intrathecal baclofen on spasticity in individuals with chronic spinal cord injury:a systematic review. J Spinal Cord Med, 2014, 37(1):11-18.
21 Handa Y, Handa T, Ichie M, et al. Functional electrical stimulation(FES)systems for restoration of motor function of paralyzed muscles--versatile systems and a portable system. Front Med Biol Eng, 1992, 4(4):241-255.
22 Shimada Y, Sato K, Matsunaga T, et al. Closed-loop control using a stretch sensor for restoration of standing with functional electrical stimulation in complete paraplegia. Tohoku J Exp Med,2001, 193(3):221-227.