双靶点取穴电针治疗创伤性四肢周围神经损伤28例临床观察

Traumatic Peripheral Nerve Injury of Limbs in 28 Cases Treated by Electroacupuncture with Double-target Acupoints Selection Protocol

目的观察并比较双靶点取穴与单靶点取穴电针治疗创伤性四肢周围神经损伤的临床疗效。方法选取56例创伤性四肢周围神经损伤患者,随机分为对照组和治疗组各28例。对照组患者采用传统单靶点取穴方案(在外周沿神经干走向循经取穴)治疗,治疗组患者采用双靶点取穴方案(督脉取穴配合外周循经取穴)治疗,两组在选穴进针后皆采用电针仪治疗30min,隔日治疗1次,每周3次,共治疗15周。分别于治疗前后采用肌电图检测两组患者运动神经波幅及传导速度、感觉神经波幅及传导速度,治疗后评估临床疗效及神经电生理疗效。结果两组患者临床疗效比较,治疗组总有效率(89.3%,25/28)与对照组(78.6%,22/28)比较差异无统计学意义(P>0.05),治疗组优良率(67.9%,19/28)与对照组(39.3%,11/28)比较差异有统计学意义(P<0.05)。两组患者神经电生理疗效比较,治疗组总有效率(92.9%,26/28)与对照组(78.6%,22/28)比较差异无统计学意义(P>0.05),治疗组愈显率(42.9%,12/28)与对照组(14.3%,4/28)比较差异有统计学意义(P<0.05)。治疗后,两组运动神经和感觉神经波幅、传导速度与治疗前比较均明显提高;治疗组运动神经波幅、传导速度均较对照组提高明显(P<0.05)。结论单靶点取穴和双靶点取穴电针方案皆能有效促进周围神经损伤后神经功能的恢复,但双靶点取穴方案的疗效更好,且能更显著地促进损伤神经在电生理指标方面的改善。

Objective To compare the clinical effect of electroacupuncture with double-target acupoints selection protocol and single-target acupoints selection protocol in the treatment of traumatic peripheral nerve injury of limbs.Methods Fifty-six patients with limb dysfunction caused by traumatic peripheral nerve injury were randomly divided into control group and treatment group with 28 cases in each group.The patients in the control group were treated with traditional single-target acupoints selection protocol,i.e.acupoints were selected along the route of the peripheral nerve trunk,while the patients in the treatment group were treated with the improved double-target acupoints selection protocol,i.e.acupoints were additionally selected along du mai(Governing Vessel).Both groups were treated with electroacupuncture for 30 minutes,once every other day,three times a week,for 15 weeks in total.Electromyography was performed to test the amplitudes and conduction velocities of motor and sensory nerves before and after treatment.The clinical effect and neuro-electrophysiological effect were evaluated after treatment.Results The total effective rate of treatment group was 89.3%(25/28),while that of control group was 78.6%(22/28),with no significant difference between groups(P>0.05);however,the marked effective rate of treatment group was 67.9%(19/28),which was significantly higher than 39.3%(11/28)of control group(P<0.05).In terms of neuro-electrophysiological effect,the total effective rate of treatment group and control group was 92.9%(26/28)and 76.6%(22/28)respectively,and the difference between groups were not statistically significant(P>0.05);the marked effective rate was 42.9%of treatment group,which was significantly higher than 14.3%(4/28)of control group(P<0.05).The amplitudes and conduction velocities of motor and sensory nerves after treatment were significantly improved than before treatment in both groups;and the improvements were more obviously in treatment group than in control group(P<0.05).Conclusion Both single-target and double-target acupoint selection protocols of electroacupuncture can effectively promote the recovery of nerve function after peripheral nerve injury,and the double-target electroacupuncture protocol is more effective,and has better improvements of electrophysiological indexes of the injured nerves.