发散式体外冲击波联合常规康复治疗对周围性面瘫的疗效观察

Therapeutic effect of extracorporeal shock wave combined with routine rehabilitation therapy for peripheral facial para-lysis

目的:探究发散式体外冲击波联合常规康复治疗对周围性面瘫的临床疗效。方法:纳入周围性面瘫患者40例,随机分为对照组和观察组各20例。对照组采用常规综合康复治疗,观察组在对照组基础上联合发散式体外冲击波进行治疗,共治疗4周。在治疗前、治疗2周、治疗4周后分别使用Sunnybrook面部分级量表(SFGS)、面神经残疾指数量表[面部残疾躯体功能指数(FDIP)、面部残疾社会生活功能指数(FDIS)]、汉密尔顿焦虑量表(HAMA)、健患侧面部温差(额温差、颧温差、口温差)对疗效进行评估。在治疗2周、治疗4周后亦进行表面肌电图检测。结果:治疗前,2组患者SFGS、FDIP、FDIS、HAMA评分、面部两侧温差比较均无显著性差异;与治疗前相比,治疗2周、4周后,2组患者SFGS、FDIP评分均增加(均P<0.05),FDIS评分、HAMA评分减少(均P<0.05),患侧面部额温差、口温差减少(均P<0.05),面神经传导速度、波幅均增加(均P<0.05);治疗2周后,观察组SFGS、FDIP评分优于对照组(均P<0.05);治疗4周后,与对照组相比,观察组SFGS、FDIP评分增加,FDIS评分降低,颧温差、口温差减少,面神经传导速度、波幅增加(均P<0.05)。结论:联合应用发散式体外冲击波和常规康复治疗对周围性面瘫疗效更佳,为发散式体外冲击波在神经肌肉损伤疾患中的应用打开新的思路。

Objective:To explore the curative effectiveness of extracorporeal shock wave combined with conventional rehabilitation for peripheral facial paralysis.Methods:A total of 40 patients with peripheral facial palsy were included and randomly divided into control group and observation group,with 20 cases in each group.The control group received conventional comprehensive rehabilitation treatment,and the observation group received combined treatment with divergent extracorporeal shock wave on the basis of the control group,for a total of 4 weeks.Sunnybrook facial rating scale,facial disability physical function index(FDIP),facial disability social life function index(FDIS),Hamilton anxiety scale,temperature difference(frontal temperature difference,zygomatic temperature difference,mouth temperature difference),surface electromyography(EMG)were used before treatment,2 weeks and 4 weeks after treatment to evaluate efficacy.The surface EMG was done 2 and 4 weeks after treatment.Results:Before treatment,there were no significant differences in Sunnybrook score,FDIP,FDIS,anxiety,frontal temperature difference,zygomatic temperature difference and oral temperature difference between 2 groups.With the extension of treatment time,Sunnybrook score,FDIP,FDIS,anxiety,frontal temperature difference,oral temperature difference,facial nerve conduction velocity and amplitude were improved in 2 groups(P<0.05),but frontal temperature difference was not significantly improved.After 2 weeks of treatment,Sunnybrook score and FDIP level in observation group were better than those in control group,and the difference was statistically significant(P<0.05);There were no significant differences in FDIS,anxiety,frontal temperature difference,zygomatic temperature difference,oral temperature difference,facial nerve conduction velocity and wave amplitude.After 4 weeks of treatment,there were significant difference in Sunnybrook score,FDIP,FDIS,zygomatic temperature difference,oral temperature difference,facial nerve conduction velocity and amplitude between two groups(P<0.05),while anxiety and frontal temperature difference had no statistical significance.Conclusion:The combined application of extracorporeal shock wave and conventional rehabilitation therapy is more effective for peripheral facial paralysis,and the application of divergent extracorporeal shock wave in the field of nervous system is worthy of further discussion.