针刺对痉挛型脑瘫患儿下肢肌张力的影响

Effects of acupuncture on muscle tension of lower limb in children with spastic cerebral palsy

目的:观察阴阳经不同经穴针刺治疗对痉挛型脑瘫患儿下肢肌张力的影响。方法:选取2~6岁痉挛型脑瘫患儿90例,分为阴经针刺组、阳经针刺组及康复组,各30例。康复组采用常规康复治疗;阴经针刺组在康复组治疗基础上加阴经取穴针刺治疗,穴取血海、阴陵泉、三阴交、太溪、太冲;阳经针刺组在康复组治疗基础上加阳经取穴针刺治疗,穴取伏兔、足三里、阳陵泉、光明、悬钟。3组治疗均为隔日1次,10次为一疗程,共治疗20d。分别于治疗前后行下肢改良Ashworth(MAS)量表、临床痉挛指数量表评分及腓肠肌表面肌电图肌电积分值(iEMG)检测。结果:治疗后,MAS分级、痉挛程度改善方面,阴经针刺组、阳经针刺组较治疗前改善明显,差异均有统计学意义(P<0.05,P<0.01),康复组与治疗前比较差异无统计学意义(均P>0.05);阴经针刺组、阳经针刺组与康复组比较,差异有统计学意义(P<0.05,P<0.01);阴经针刺组和阳经针刺组比较差异无统计学意义(均P>0.05)。与治疗前比较,治疗后阴经针刺组和阳经针刺组双侧iEMG均降低(均P<0.05),康复组右侧iEMG升高(P<0.05);治疗后阴经针刺组、阳经针刺组i EMG均低于康复组(均P<0.05),治疗前后iEMG差值高于康复组(均P<0.05);治疗后阴经针刺组和阳经针刺组iEMG比较差异无统计学意义(均P>0.05)。结论:阴阳经针刺均可降低痉挛型脑瘫患儿下肢肌张力、改善肢体痉挛程度,且治疗效果相当。

Objective To observe the effects of acupuncture at different acupoints in yin meridians and yang meridians on lower limb muscle tension in children with spastic cerebral palsy. Methods Ninety children with spastic cerebral palsy aged between 2 to 6 years old were divided into a yin-meridian group, a yang-meridian group and a rehabilitation group, 30 cases in each one. The patients in the rehabilitation group were treated with routine rehabilitation treatment; the patients in the yin-meridian group were treated with routine rehabilitation treatment and acupuncture at Xuehai（SP10）, Yinlingquan（SP9）,Sanyinjiao（SP6）, Taixi（KI3） and Taichong（LR3） along yin meridians; the patients in the yang-meridian group were treated with routine rehabilitation treatment and acupuncture at Futu（ST32）, Zusanli（ST36）, Yanglingquan（GB34）, Guangming（GB37） and Xuanzhong（GB 39） along yang meridians. All the three groups were treated once each other day, 10 times as one course, and totally 20-day treatment was given. Before and after treatment, modified Ashworth scale（MAS）, clinical spasm index（CSI） and integrated electromyography（i EMG） of surface electromyogram of gastrocnemius muscle were evaluated. Results Compared before treatment, the MAS and CSI in the yin-meridian group and yang-meridian group were improved after treatment（P〈0.05, P〈0.01）; the differences before and after treatment in the rehabilitation group were not significant（both P〈0.05）. After treatment, the differences between the rehabilitation group and yin-meridian group, yang-meridian group were significant（P〈0.05, P〈0.01）; the differences of MAS and CSI between the yin-meridian group and yang-meridian group were not significant（both P〉0.05）. Compared before the treatment, the right-side i EMG and left-side i EMG were reduced in the yin-meridian group and yang-meridian group（all P〈0.05）; the right-side i EMG was increased in the rehabilitation group（P〈0.05）. After treatment,the i EMG in the yin-meridian group and yang-meridian group were lower than that in the rehabilitation group（all P〈0.05）; the differences of i EMG before and after treatment in the yin-meridian group and yang-meridian group were higher than that in the rehabilitation group（all P〈0.05）; the differences of i EMG between the yin-meridian group and yang-meridian group were not significant（both P〉0.05）. Conclusion Acupuncture at yin meridians and yang meridians could reduce muscle tension of lower limb and improve limb spasticity in children with spastic cerebral palsy, and the two acupuncture methods have similar clinical curative effect.