Therapeutic efficacy of acupuncture plus Tuina for spastic cerebral palsy and discussion of its mechanism

针刺联合推拿治疗痉挛型脑瘫的疗效及机制探讨

Objective To discuss the effects of acupuncture plus Tuina(Chinese therapeutic massage)in intervening the mental development,motor function,cerebral hemodynamics,and muscle tone in kids with spastic cerebral palsy(CP).Methods A retrospective analysis was conducted on 87 kids with spastic CP.They were divided into a control group and an observation group based on their original treatment plan.Kids in the control group received symptomatic treatment,motor development therapy,and Tuina treatment.The observation group was additionally given acupuncture treatment.One month was taken as a treatment course.After six courses,the efficacy,change in muscle tone,mental development,gross motor function,fine motor function,and the systolic velocity(Vs),mean velocity(Vm),and pulsatility index(PI)of the anterior cerebral artery(ACA),middle cerebral artery(MCA),and posterior cerebral artery(PCA)were compared between the two groups.Results After treatment,the muscle tone score dropped in both groups(P<0.05)and was significantly lower in the observation group than in the control group(P<0.05).The observation group achieved more significant efficacy than the control group(P<0.05).After the intervention,the mental development index(MDI),psychomotor development index(PDI),gross motor function measure(GMFM)score,and fine motor function measure(FMFM)score all increased in both groups(P<0.05)and were notably higher in the observation group than in the control group(P<0.05).After treatment,the Vs and Vm of the ACA,MCA,and PCA were markedly higher in the observation group than in the control group(P<0.05),and the observation group was significantly lower than the control group comparing the PI of the ACA,MCA,and PCA(P<0.05).Conclusion Based on the symptomatic treatment and motor development therapy,Tuina and acupuncture treatment can effectively treat spastic CP children,manifesting as reducing muscle tone,boosting mental development,and improving motor function and cerebral hemodynamics.

目的探讨针刺联合推拿对痉挛型脑瘫(CP)患儿智力发育、运动功能、脑血流动力学和肌张力的干预作用。方法对87例痉挛型CP患儿进行回顾性分析,根据患儿原治疗方案分为对照组和观察组。对照组患儿接受对症治疗、运动发育疗法和推拿治疗,观察组在对照组治疗基础上加用针刺治疗,1个月为1疗程。比较两组患儿治疗6个疗程后的疗效情况、肌张力变化、智力发育、粗大运动功能、精细运动功能以及大脑前动脉(ACA)、大脑中动脉(MCA)和大脑后动脉(PCA)血流收缩期峰值流速(Vs)、平均峰值流速(Vm)和搏动指数(PI)。结果治疗后两组患儿肌张力等级评分均下降(P<0.05),且观察组明显低于对照组(P<0.05)。观察组疗效明显优于对照组(P<0.05)。治疗后两组智力发育指数(MDI)和心理运动发育指数(PDI)、粗大运动功能测定(GMFM)评分和精细运动功能评定(FMFM)评分均升高(P<0.05),且观察组明显高于对照组(P<0.05)。治疗后观察组ACA、MCA、PCA的Vs、Vm均明显高于对照组(P<0.05),ACA、MCA、PCA的PI均明显低于对照组(P<0.05)。结论在对症治疗和运动发育疗法基础上加用推拿及针刺治疗对痉挛型CP患儿疗效肯定,可有效降低患儿肌张力,促进智力发育,提高运动功能,同时改善脑部血流动力学。