互动式头针对痉挛型脑瘫患者步态时空参数的影响

摘要

Objective To study the effect of scalp acupuncture plus facilitation technique on the temporal and spatial parameters of gait in spastic cerebral palsy. Method Thirty eligible patients with spastic cerebral palsy were randomized into a treatment group and a control group based on the inter-group balance in age, palsy type, and the Gross Motor Function Classification System (GMFCS), 15 cases in each group. The treatment group was intervened by scalp acupuncture, together with the facilitation technique during the retaining of the needles; the control group was also by scalp acupuncture and facilitation techniques but with over 1 h interval between the two methods. The treatment was given once a day, totally for 3 months. The walking, running, and jumping items (E category) of the Gross Motor Function Measure-66 (GMFM-66), temporal and spatial parameters of gait, and vertical ground reaction force during stance were compared before and after the treatment. Result There were no significant inter-group differences in comparing the rates of E category of the GMFM-66 before the treatment (P>0.05), the rates were significantly changed after the treatment in both groups (P<0.05), and there were significant differences in comparing the rates between the two groups after the intervention (P<0.05);after the intervention, the step length, walking speed, and step frequency were increased significantly in both groups (P<0.05), while the double-stance phase was decreased significantly, and swing phase was increased significantly (P<0.05); after the intervention, the step length, walking speed, and step frequency of the treatment group were significantly better than that of the control group (P<0.05). Conclusion Acupuncture plus facilitation technique can mitigate the spasticity in spastic cerebral palsy, improve the gross motor function, especially the function of standing and walking, enhance the activities, and benefit the improvement of the step length, step width, and walk speed.%目的：研究头针与易化技术相结合对治疗痉挛型脑瘫患者步态时空参数的影响。方法将符合纳入标准的30例痉挛型脑瘫患者，根据年龄、瘫痪类型及粗大运动功能分级(GMFCS)组间均衡的原则随机分为治疗组和对照组，每组15例。治疗组在头针留针的同时，采用易化技术进行训练；对照组在头针治疗和易化技术训练之间间隔1h以上。治疗每日1次，共观察3个月。比较治疗前后GMFM-66项走、跑、跳(E功能区)百分比及步态时空参数及蹬离过程中上下方向地面反作用力参数变化。结果两组治疗前GMFM-66项E功能区百分比比较差异无统计学意义(P＞0.05)，两组治疗前后GMFM-66项E功能区百分比比较差异具有统计学意义(P＜0.05)，两组治疗后GMFM-66项E能区百分比比较差异具有统计学意义(P＜0.05)；两组治疗后患者步长、步速、步频较治疗前增大，差异均有统计学意义(P＜0.05)，双支撑相较治疗前减少，摆动相较治疗前增加，差异均有统计学意义(P＜0.05)；治疗后治疗组步长、步速、步频较对照组增大，差异均有统计学意义(P＜0.05)。结论针刺结合易化技术可以缓解痉挛型脑瘫患者的痉挛，改善粗大运动功能，尤其是站和走的功能，增强活动能力，有利于改善痉挛型脑瘫患者步长、步宽、步速。