中医综合疗法对青少年特发性脊柱侧凸患者肺功能及表面平均肌电比值的影响

Influences of combined therapies with traditional Chinese medicine on pulmonary function and surface average electromyogram ratio in adolescent idiopathic scoliosis patients

目的评价中医综合疗法(导引、推拿、小针刀)对青少年特发性脊柱侧凸(AIS)患者肺功能和表面平均肌电(AEMG)比值的影响。方法 120例AIS门诊患者随机分为中医治疗组(治疗组)和支具对照组(对照组)。治疗组采用脊柱平衡导引(2次/d,40min/次,每天坚持直至骨骼发育成熟)、脊柱平衡推拿(3次/周,25min/次,12个月)及小针刀整体松解(1次/周,共10次)治疗。对照组采用Milwaukee支具治疗(22h/d,12个月)。观察治疗前及治疗后12个月时的肺功能指标[肺活量(VC)、第1秒用力呼气容积占用力肺活量的百分比(FEV1/FVC)、每分钟最大通气量(MVV)]改变,治疗前及治疗后12、24个月时的Cobb角改变,治疗前及治疗后6、12、18、24个月时AEMG比值变化,并对各指标进行组间比较。结果治疗后12个月治疗组和对照组Cobb角矫正率(分别为51.4%、47.8%)差异无统计学意义(P>0.05),而治疗后24个月治疗组Cobb角矫正率(62.5%)明显高于对照组(34.7%,P<0.05)。与治疗前比较,治疗组治疗后12个月VC、FEV1/FVC、MVV明显升高(P<0.05),而对照组治疗后12个月各指标均有不同程度下降(P<0.05)。治疗组治疗后6、12、18、24个月时AEMG比值持续降低并趋向于1,表明侧凸两侧的肌张力趋于平衡,而对照组比值AEMG比值逐渐增加,表明侧凸两侧的肌张力不平衡加剧。两组治疗中均未发生明显的不良反应。结论基于改善AIS脊柱内外平衡失调的中医脊柱平衡法能显著改善肌力的不平衡,减轻侧凸,提高肺功能,值得推广应用。AEMG比值可用于评价AIS的治疗效果及评估侧凸的进展。

Objective To evaluate the influences of traditional Chinese medicinal combined therapies on pulmonary function and surface average electromyogram（AEMG） ratio in adolescent idiopathic scoliosis patients. Methods One hundred and twenty outpatients with mild and moderate adolescent idiopathic scoliosis were randomly divided into a Traditional Chinese Medicine（TCM） group and a brace group. TCM group patients underwent i） Navigation of the spinal balance（twice a day, 40min/time）, until to skeletal maturity; ii） Balance manipulation（twice a week, 25min/time）, lasted 12 months; iii） Small needle-knife therapy（once a week, 10 times）. The brace group patients were treated with a Milwaukee brace. The Cobb angle was measured after 12 and 24 months of treatment, pulmonary function was determined after 12 months of treatment, and AEMG ratio of the surface electromyogram was measured 6, 12, 18 and 24 months after treatment, and intergroup comparison was performed. Results The Cobb angle significantly decreased in both groups 12 months after treatment（P〈0.05）; correction percentage was 51.4% and 47.8%（P〉0.05） in the TCM group and brace group, respectively, 12 months after treatment and 62.5% and 34.7%（P〈0.05）, respectively, 24 months aftertreatment. Pulmonary function was significantly improved 12 months after treatment in TCM group（P〈0.05） but significantly decreased in brace group（P〈0.05）. The AEMG ratio was significantly reduced（P〈0.01） and tended to remain at 1 after stopping treatment in TCM group, showed that the muscle imbalance existed on both sides of the scoliosis, but was adverse in brace group（P〈0.05）, showed that the muscle imbalance aggravated. No side effect of the therapeutic method was found. Conclusions The spinal balance therapy based on traditional Chinese medicine theory has excellent therapeutic efficacy and safety, and can significantly ameliorate the imbalance existed on both sides of the scoliosis, improve lung function index, and have better compliance. The AEMG ratio is a new strategy that could replace radiography in evaluation of therapeutic efficacy and progression in scoliosis, thus avoiding the repeated X-ray exposure to the body.