悬吊运动训练配合揿针对脑性瘫痪中痉挛型双瘫的康复疗效分析

Analysis of rehabilitation efficacy of sling exercise training combined with press needle therapy in spastic diplegic cerebral palsy

摘要

目的 探究揿针联合悬吊运动训练对脑性瘫痪（简称脑瘫）中痉挛型双瘫患儿粗大运动功能的康复疗效。方法 选取2021年1月至2022年1月赣州市妇幼保健院儿童神经康复科收治住院的痉挛型双瘫的脑瘫患儿22例为研究对象, 按随机数字表法分为观察组和对照组各11例。对照组接受常规悬吊运动训练干预, 观察组在悬吊运动训练基础上联合揿针疗法[取穴环跳（GB30）、足三里（ST36）、阳陵泉（GB34）、承山（BL57）、三阴交（SP6）、肾俞（BL23）等]。干预3个月后, 采用脑瘫粗大运动功能测试量表（GMFM-88）的D区（站立）、E区（行走、跑和跳）及总分评估粗大运动功能。采用改良Ashworth量表（MAS）评估腘绳肌及小腿三头肌的肌张力。分析两组疗效差异。结果 治疗前两组GMFM-88 D区、E区、总分及MAS评分比较, 差异均无统计学意义（P>0. 05）。干预3个月后, 两组D区得分比较差异无统计学意义（P>0. 05）；观察组E区得分及总分均显著高于对照组, 差异均有统计学意义（P<0. 05）。肌张力方面, 两组患儿治疗后腘绳肌、小腿三头肌MAS评分均低于治疗前, 差异有统计学意义（P<0. 05）。治疗后两组患儿腘绳肌、小腿三头肌MAS评分比较差异无统计学意义（P>0. 05）。结论 揿针联合悬吊运动训练能有效改善痉挛型双瘫患儿的动态运动功能及整体粗大运动能力, 降低腘绳肌、小腿三头肌的肌张力, 其“内通经络、外调筋骨”的协同作用优于单纯悬吊运动训练, 可为后续大样本随机对照研究提供初步依据。

Abstract

Objective To explore the rehabilitation efficacy of press needle therapy combined with sling exercise training (SET) on gross motor function in children with spastic diplegic cerebral palsy (CP). Methods A total of 22 CP children with spastic diplegia who were treated in Neurorehabilitation Department of Ganzhou Maternal and Child Health Hospital from January 2021 to January 2022 were selected as research subjects. According to the random number table method, they were divided into a treatment group (n=11) and a control group (n=11). The control group received conventional SET, while the treatment group received press needle therapy [selecting acupoints including "Huantiao (GB30)", "Zusanli (ST36)", "Yanglingquan (GB34)", "Chengshan (BL57)", "Sanyinjiao (SP6)", and "Shenshu (BL23)"] in addition to SET. After 3 months of intervention, gross motor function was assessed using the gross motor function measure-88 (GMFM-88), including Dimension D (standing), Dimension E (walking, running, and jumping), and the total score; muscle tone of the hamstrings and gastrocnemius-soleus was evaluated using the modified Ashworth scale (MAS). Results Before treatment, there were no statistically significant differences in the scores of GMFM-88 Dimension D, Dimension E, total scores, or MAS scores between the two groups (P>0. 05). After 3 months of intervention, there was no statistically significant difference in Dimension D scores between the two groups (P>0. 05); however, the Dimension E scores and total scores in the treatment group were significantly higher than those in the control group (P<0. 05). Regarding muscle tone, in both groups, the post-treatment MAS scores of the hamstrings and triceps surae were lower than the pre-treatment scores, with statistically significant differences (P<0. 05). After treatment, no statistically significant difference was found in the MAS scores of the hamstrings and triceps surae between the two groups (P>0. 05). Conclusion Press needle therapy combined with SET can effectively improve the dynamic motor function and overall gross motor ability of children with spastic diplegic CP and significantly reduce the muscle tone of hamstrings. Its synergistic effect of "internally unblocking meridians and externally regulating tendons and bones" is superior to SET alone, which provides initial evidence for subsequent large-sample randomized controlled studies.

关键词

脑性瘫痪 / 痉挛型双瘫 / 悬吊运动训练 / 揿针 / 粗大运动功能 / 儿童

Key words

Cerebral palsy / Spastic diplegia / Sling exercise training / Press needle therapy / Gross motor function / Child

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基金资助

江西省中医药管理局科技计划课题(2022B850)