腕踝针治疗痉挛型脑瘫儿童尖足的临床研究

Clinical study on wrist-ankle acupuncture for tiptoeing in children with spastic cerebral palsy

目的评价腕踝针对痉挛型脑瘫（cP）尖足步态的影响。方法将2011年1月至2013年1月在广州中医药大学附属南海妇产儿童医院收治的60例1~3岁痉挛型CP患儿，按照就诊先后顺序进行编号，采用Stata11．0软件产生随机数字分组，随机分为治疗组与对照组各30例，治疗组采用腕踝针，对照组针刺环跳、阳陵泉、足三里、三阴交、解溪、太冲穴。两组针灸治疗均隔日1次，10次为1疗程，疗程间隔15d，连续治疗3个疗程。两组分别于治疗前、治疗1个疗程后、治疗3个疗程后，采用足背屈角测量、综合痉挛量表（CSS）、改良Ashworth量表（MAS）进行康复评定。用SPSS16．0软件进行统计分析。治疗前年龄、足背屈角、CSS痉挛评分的基线资料比较采用t检验；治疗1个疗程后和3个疗程后的足背屈角、CSS痉挛评分比较采用重复测量数据的方差分析；治疗前后MAS分类资料的比较采用，检验。以P〈0．05为差异有统计学意义。结果观察组足背屈角测量1个疗程后及3个疗程后效应均优于对照组（t=-3．06、t=-2．42，均P〈0．05）；观察组CSS评分1个疗程及3个疗程后效果均优于对照组（t=-2．62、t=-3．10，均P〈0.05）；观察组与治疗组治疗1个疗程及3个疗程后，MAS未见明显差异（X2=1．068、X2=1．088，均P〉0．05）。结论腕踝针可改善痉挛型cP患儿尖足步态，改善踝关节活动度及痉挛程度。

Objective The aim of this study was to discuss the effect of wrist-ankle acupuncture on the tiptoeing in children with spastic cerebral palsy（CP）. Methods The study consisted of 60 children with spastic CP,who were carried out in accordance with the medical order number and then randomized to two groups according to the random number generated by Stata 11.0 package. There were 30 cases in treatment group and 30 in control group. Both groups received basis treatment. The treatment group was also treated with wrist-ankle acupuncture,and the control group was treated by acupuncture in Huantiao （GB 30）, Yanglingquan（GB 34）,Zusanli（ST 36）,Sanyingjiao（SP 6）,Jiexi（ST 41 ） and Taichong（LR 3）. Both of them received acupuncture once every other day and 10 times as a course of treatment. Patients received continuous treatment of three courses with 15 d interval. Subjects were assessed by angle measurement of ankle passive dorsiflexion,comprehensive spasm scale （CSS）and Modifide Ashworth Scale （MAS）before and after 1 course of treatment and after 3 courses of treatment. SPSS 16.0 software was used to perform statistical analysis and P〈0.05 was thought to have statistical difference. The clinical data of age,foot dorsiflexion angle and CSS score before treatment were compared using t-test. The repeated measures analysis of variance data were used to detect the difference of foot dorsiflexion angle and CSS scores afterone course and 3 courses of treatment. The chi-square test was used to compare the frequency differences of MAS classification before and after treatment. Results The foot dorsiflexion angle was better in treatment group than that of control group after 1 period of treatment and 3 periods of treatment（t=-3,06,t=-2.42, P〈O.05 ）. The CSS score was higher in treatment group after 1 period of treatment and 3 periods of treatment than that of control group（t=-2.62, t=-3.10,P〈0.05）. There was no significant difference in the level of MAS between treatment group and control group （treatment group：X2=l.068,control group：X2=l.088,P〉0.05）. Conclusion The wrist-ankle acupuncture can improve tiptoe gait,ankle passive dorsiflexion and spasm in children with spastic CP.