小针刀治疗痉挛型脑瘫疗效观察 

2006年11月3日11:32


摘要 目的观察小针刀疗法降低痉挛型脑瘫患者肌张力的疗效。方法:105例痉挛型脑瘫患者随机分为A组(小针刀组35例)、B组(运动疗法组34例)和C组(小针刀加运动疗法36例)共三组。治疗前和治疗后1月时分别由康复评定师用改良的Ashworth肌张力评定分级量表评定,以肌张力降低一个级别以上为有效。将结果用χ2检验。结果:A组有23例有效, 有效率65.71%,B组10例有效,有效率29.41%,C组有效28例,有效率77.78%。B组有效率明显低于A和C组,有显著差异(P<0.00313和P<0.00227),A组与C组两组之间有效率无显著差异(P>0.0125)。结论:小针刀疗法在改善痉挛型脑瘫患者的肌张力方面明显优于运动疗法。
关键词小针刀 痉挛 脑瘫 肌张力

To observe the effect of spasticity cerebral palsy been treated by Acupotomy YAN Bing-cang, Qing feng, ZHAO Xiao-li. Xi’an traditional Chinese medical brain hospital, Xi’an 710068,Shanxi china
Abstract: objective To observe the effect of spasticity cerebral palsy been treated by Acupotomy. Methods 105 cases of spasticity cerebral palsy were random divided into group A (acupotomy group with 35) and group B (physical therapy group with 34) and group C (acupotomy and physical therapy group with 36). Doctor of Rehabilitation assesses muscular tension using Modified Ashworth Scale (MAS) in the front and after a month of therapy. It is in effect that muscular tension falls one scale. Result was checked up by χ2test. Results Effective of sum A group were 23, effective rate of group A were 65.71%, those of the group B were 10 and 29.41% respectively, and the group C were 28 and 77.78%. the effective rate of group B was significantly less than group A and C, there was a significantly difference among three groups (P<0.00313和P<0.00227, No difference both group A and C(P>0.0125).Conclusion Acupotomy. exceed physical therapy in reducing muscular tension of spasticity cerebral palsy.
Key words: Acupotomy; spasm; cerebral palsy; muscular tension;
痉挛型(spasticity)脑瘫(cerebral palsy)占全部脑瘫患儿的60—70%1,是临床最常见的类型。目前针对痉挛型脑瘫普遍应用运动疗法(Bobath法)治疗的时间长,起效慢,花费大的问题,我们从2005年10月开始采用小针刀疗法与运动疗法的治疗进行对比观察。先将结果报告如下:
1 对象与方法
1.1对象 105例为2005-10/2006-06在我院住院的脑性瘫痪(脑瘫)患儿,全部均符合1988年全国小儿脑瘫学术会议确定的标准2。其中男61例,女44例。年龄在2—4岁。分型:均选痉挛型,双下肢瘫痪(截瘫)58例,双瘫(四肢均受累,以双下肢受累较双上肢重)31例,四肢瘫(四肢均受累,上下肢受累程度类似)6例,偏瘫4例,双重偏瘫(四肢均受累,双上肢重,下肢轻,或左右两侧严重程度不一致)3例,三肢瘫3例。痉挛分级:用改良的Ashworth肌张力(痉挛)评定分级,Ⅰ+级9例,Ⅱ级50例,Ⅲ级46例。合并症:智力低下15例,癫痫29例,语言障碍31例,小头畸形9例,听力障碍7例,斜视13例,牙齿发育畸形16例。采取系统随机化法(用患者病历号交替)分组。小针刀采用北京华夏医疗器械厂生产的Ⅷ型注射式刀。
1.2方法 各组患者在治疗前均由康复评定师用改良的Ashworth肌张力(痉挛)评定分级量表进行肌张力评定。A组患者行小针刀治疗,观察的1个月内的第1天和第11天进行小针刀治疗;B组采取运动疗法(Bobath法3),每天治疗1次,每次45分钟,由康复治疗师完成;C组在运动疗法(Bobath法)的基础上行小针刀治疗(治疗方法和次数同A组),小针刀术后的第三天开始运动疗法(每天治疗1次,每次45分钟)。治疗1月后由同一康复评估师再次评定肌张力。
小针刀操作,遵循四步规程,即定点、定向、加压分离、刺入。应用切割肌纤维法4
1.3疗效评定 采用改良的Ashworth痉挛量表(Modified Ashworth Scale MAS)5,治疗前后肌张力降低1个级以上(包括1个级别)别定

为有效。
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