头针结合低频重复经颅磁刺激对痉挛型脑瘫患儿运动及认知功能的疗效研究

Therapeutic effect of scalp acupuncture combined with low frequency repetitive transcranial magnetic stimulation on motor and cognitive function of children with spastic cerebral palsy

目的观察头针结合低频重复经颅磁刺激(LF-rTMS)对痉挛型脑瘫患儿运动及认知功能的疗效。方法选取2021年1月至2022年12月广东省妇幼保健院收治的90例痉挛型脑瘫患儿,按照随机数字表法分为头针组、LF-rTMS组和结合组,每组30例,3组患儿在接受常规的康复治疗基础上分别增加头针、LF-rTMS、头针结合LF-rTMS治疗,每天1次,每周6次,连续12周。于治疗前及治疗12周后,评估3组患儿的肌张力[改良Ashworth量表(MAS)]、粗大运动功能[粗大运动功能量表88项(GMFM)]及认知功能(Gesell发育量表)。采用方差分析、配对t检验、χ^(2)检验或Fisher确切概率法、Z检验、配对秩和检验进行统计比较。结果治疗前,3组患儿的MAS评分、GMFM的D区及E区评分、Gesell的5个功能区评分比较,差异均无统计学意义(均P>0.05)。治疗后,头针组、LF-rTMS组和结合组的MAS评分[(2.13±0.63)分比(1.93±0.64)分比(1.50±0.57)分,F=8.332]、GMFM的D区[(14.10±5.30)分比(11.83±3.95)分比(14.70±4.56)分,F=3.196]及E区[(8.96±4.02)分比(9.60±4.26)分比(11.88±3.72)分,F=4.416]评分和Gesell的适应性[(52.69±19.05)分比(52.45±21.25)分比(63.33±10.35)分,F=3.772]、大运动[(31.53±12.65)分比(30.32±12.49)分比(38.18±11.99)分,F=3.513]、语言功能区[(50.01±19.38)分比(50.92±19.60)分比(60.73±11.76)分,F=3.541]评分比较,差异均有统计学意义(均P<0.05);结合组的MAS评分、GMFM E区评分和Gesell的适应性、大运动、语言评分优于头针组和LF-rTMS组,差异均有统计学意义(均P<0.05);结合组的GMFM D区评分优于LF-rTMS组(P<0.05)。结论头针结合LF-rTMS可有效降低痉挛型脑瘫患儿的肌张力,提高其运动及认知功能。

Objective To explore the effect of scalp acupuncture combined with low frequency repetitive transcranial magnetic stimulation on motor and cognitive function in children with spastic cerebral palsy.Methods Ninety children with spastic cerebral palsy treated at Guangdong Women and Children Hospital from January 2021 to December 2022 were recruited and randomly divided into a scalp acupuncture group,an LF-rTMS group,and an associative group by the random number table method,with 30 cases in each group.The three groups were treated with conventional rehabilitation therapy.On this basis,the scalp acupuncture group took scalp acupuncture,the LF-rTMS group low-frequency repetitive transcranial magnetic stimulation,and the associative group scalp acupuncture and low-frequency repetitive transcranial magnetic stimulation.All the three groups were continuously treated 1 time/day and 6 times/week for 12 weeks.Before and after 12 weeks'treatment,the three groups were evaluated using the Gross Motor Function Measure(GMFM-88),Modified Asthworths Scale(MAS),and Gesell Developmental Schedules(Gesell).Analysis of variance,paired t test,χ^(2) test or Fisher exact probability,Z test,and paired rank sum test were applied.Results Before the treatment,there were no statistical differences of MAS,D and E divisions of GMFM,and 5 divisions of Gesell between the three groups(all P>0.05).After the treatment,there were statistical differences in the MAS score[(2.13±0.63)vs.(1.93±0.64)vs.(1.50±0.57),F=8.332],the D[(14.10±5.30)vs.(11.83±3.95)vs.(14.70±4.56),F=3.196]and E[(8.96±4.02)vs.(9.60±4.26)vs.(11.88±3.72),F=4.416]scores of GMFM,and the adaptation[(52.69±19.05)vs.(52.45±21.25)vs.(63.33±10.35),F=3.772],motor[(31.53±12.65)vs.(30.32±12.49)vs.(38.18±11.99),F=3.513],and language[(50.01±19.38)vs.(50.92±19.60)vs.(60.73±11.76),F=3.541]scores of Gesell between the scalp acupuncture group,the LF-rTMS group,and the associative group(all P<0.05);the MAS scores,and E scores of GMFM,and the adaptation,motor,and language scores of Gesell of the associative group were significantly better than those of the scalp acupuncture group and the LF-rTMS group,with statistical differences(all P<0.05).The D score of GMFM of the associative group was significantly better than that of the LF-rTMS group(P<0.05).Conclusions Scalp acupuncture combined with low-frequency repetitive transcranial magnetic stimulation for children with spastic cerebral palsy can effectively reduce their muscle tension and promote their motor and cognitive function.