针刺治疗早期脑瘫儿坐姿异常的多中心、随机对照研究

Effect of Acupuncture on Early Cerebral Palsy Infants with Parafunctional Sitting Position: a Multicentre,Randomized, Control Research

目的 观察基于婴幼儿发育理论的针刺方案治疗早期脑瘫儿坐姿异常的临床疗效。方法 将120例早期脑瘫患儿随机分为治疗组及对照组,每组60例,均采用针刺结合康复训练的治疗方法,治疗组采用基于婴幼儿发育理论的针刺方案,对照组采用头针方案。通过粗大运动功能评估量表对不同组别、不同脑瘫类型的患儿治疗前后的坐位功能进行疗效评价;采用表面肌电仪记录坐位相关大肌肉（背阔肌、竖脊肌、腹直肌）表面肌电信号（RMS）变化;并应用尼莫地平法评价两组患儿疗效。结果 与治疗前比较,治疗后两组患儿坐位功能得分均明显提高（P〈0.01）;且治疗组坐位功能得分高于对照组（P〈0.01）;治疗组痉挛型和肌张力低下型患儿坐位功能得分的进步幅度明显高于其他类型（P〈0.01）;坐位主要相关大肌肉RMS信号变化为：随着坐位的完成,背阔肌RMS信号逐渐减弱,竖脊肌信号逐渐增强,腹直肌信号稍减弱。与对照组比较,治疗后治疗组背阔肌RMS信号明显降低,竖脊肌RMS信号明显升高（均P〈0.01）。治疗组总有效率[89.29%（50/56）]高于对照组[77.78%（42/54）],两组比较,差异有统计学意义（P〈0.05）。结论 基于婴幼儿发育理论的针刺方案可以有效提高8个月-1岁坐姿异常的早期脑瘫患儿背侧伸肌肌力,从而改善坐姿,有利于患儿坐位的完成。

Objective To study the clinical effect of development theory based acupuncture on early cerebral palsy （CP） infants with parafunctional sitting position. Methods Totally 120 early CP infants were randomly assigned to two groups equally, the treatment group and the control group. All received acu- puncture combined with training rehabilitation. Patients in the treatment group adopted acupuncture based on infants development theory, while those in the control group were treated by head acupuncture. Sitting functional points in Gross motor function measure （GMFM） 88 were observed in different groups and infant patients of various types before and after treatment. Root mean square （RMS） signals of sitting correlated muscles （latissimus dorsi, erector spinae, rectus abdominis） were recorded by surface electromyography （sEMG）. The effective rate was evaluated by Nimodipine method. Results Compared with before treat- ment, sitting functional points were significantly improved in the two groups （P 〈0.01 ）. After treatment, it was higher in the treatment group than in the control group （P 〈0.01 ）. The advance amplitude was higher inCP infants of the spastic type and the hypotonic type than other types （P 〈 0.01 ）. Along with sitting process, latissimus dorsi RMS signals were gradually tapered, erector spinae RMS signals were gradually enhanced, and rectus abdominis RMS signals were slightly weakened. Compared with the control group, la- tissimus dorsi RMS signals obviously decreased, and erector spinae RMS signals obviously increased in the treatment group after treatment （all P 〈0.01 ）. The total effective rate was higher in the treatment group than in the control group （89. 29% vs 77.78%, P 〈0. 05）. Conclusion Infants development theory based acupuncture could effectively elevate dorsi-extensor muscles force, improve sitting position of 8 months to 1 year old CP infants with parafunctional sitting position.