A型肉毒素水电针腧穴注射治疗脊髓损伤后肌痉挛的临床研究

Clinical research of electroacupuncture combined with acupoint-injection of botulinum toxin A in treating the muscle spasticity by spinal cord injury

目的:探讨A型肉毒素(BTXA)水电针腧穴注射治疗脊髓损伤后肌痉挛的安全性及疗效。方法:2006年12月至2009年12月,收治脊髓损伤后出现肌痉挛的患者38例,男26例,女12例;年龄21～68岁,平均45.4岁。按入院时间随机分为3组,A组13例,采用BTXA水电针腧穴注射;B组13例,单纯注射BTXA;C组12例,单纯电针刺激。治疗后第6个月时对患者进行改良Ashworth(MAS)评分及临床痉挛指数CSI评分。结果:治疗后第6个月时38例患者获得随访,治疗前3组患者MAS评分分别为(3.10±0.14),(3.20±0.17),(3.10±0.16)分,CSI评分分别为(14.10±0.14),(14.30±0.11),(14.20±0.12)分,两项评分术前差异无统计学意义(P>0.05);治疗后第6个月时3组患者MAS评分分别为(1.10±0.16),(2.10±0.13),(2.00±0.14)分,CSI评分分别为(9.10±0.11),(12.10±0.14),(13.10±0.12)分,A组两项评分明显优于B、C组(P<0.05)。结论:中医水电针、腧穴与BTXA注射有机结合,互相弥补不足,能达到综合治疗的目的,可以安全、快速的减少肌痉挛患者的痛苦,提高生活质量,是治疗脊髓损伤后肌痉挛的全新、效佳的方法。

Objective：To explore clinical safety and efficiency of electroacupuncture combined with acupoint-injection of botulinum toxin A for the treatment of muscle spasticity by spinal cord injury. Methods：Thirty-eight patients with muscle spasticity by spinal cord injury were treated from December 2006 to December 2009 including 26 males and 12 females,with an average age of 45.4 years old ranging from 21 to 68 years. The patients were randomly divided into 3 groups according to admission time,13 patients in group A were treated with electroacupuncture combined with acupoint-injection of botulinum toxin A,and 13 patients in group B were treated with acupoint-injection botulinum toxin A and 12 patients in group C were treated with electroacupuncture. After 6 months these patients were evaluated by improved muscle Ashworth scoring（MAS） and clinical spasticity index（SCI）. Results：Thirty-eight patients were followed-up at 6 months after the treatment. The result showed that the MAS scores of group A,B,C before treatment were（3.10±0.14）,（3.20±0.17）,（3.10±0.16） respectively and the CSI scores were （14.10±0.14）,（14.30±0.11）,（14.20±0.12） respectively;there were no statistical different among the three groups（P〉0.05）. After 6 months of treatment,the MAS scores were（1.10±0.16）,（2.10±0.13）,（2.00±0.14） respectively and the CSI scores were（9.10±0.11）,（12.10±0.14）,（13.10±0.12） respectively. The MAS scores and CSI scores of group A were better than the other two groups（P〈0.05）. Conclusion：The combination of Chinese hydropower needles and acupoints with BTX-A injection can achieve a comprehensive treatment and reduce pain and improve life quality quickly. The electroacupuncture combined with acupoint-inject botulinum toxin A is a noval safe and effective technique for the treatment of muscle spasticity by spinal cord injury.