针刺核心肌群对痉挛型脑瘫儿童步行功能及下肢表面肌电的影响

摘要/Abstract

摘要： 目的:观察核心肌群针刺对痉挛型脑瘫儿童步行功能及下肢表面肌电信号的影响。方法：将符合研究要求的痉挛型脑瘫儿童共51例随机分为综合康复组25例与核心针刺组26例。两组患儿均采用综合康复治疗，核心针刺组加用核心肌群针刺。采用粗大运动功能测试（GMFM-88) 中D、E区评分、腓肠肌和胫骨前肌积分肌电值（iEMG）、协同收缩率（CR）为主要观察指标。结果：治疗后，两组患儿GMFM-88量表D、E区评分均较治疗前提高（P<0.05），且核心针刺组评分高于综合康复组（P<0.05）。治疗后，主动活动下，两组患儿腓肠肌iEMG、胫骨前肌iEMG较治疗前均有不同程度的升高（P＜0.01），且核心针刺组升高更为明显（P＜0.05）；被动活动下，两组患儿腓肠肌iEMG、胫骨前肌iEMG 均较治疗前降低（P＜0.01），且核心针刺组降低更明显（P＜0.05）。治疗后，两组患儿腓肠肌CR、胫骨前肌CR较治疗前均降低（P＜0.05），且核心针刺组降低更明显（P＜0.05）。结论：针刺核心肌群可有效提高痉挛型脑瘫儿童站立平衡、行走运动功能，且能更好地提高腓肠肌和胫骨前肌的肌力，降低其肌张力，并可提高主动肌和拮抗肌的收缩协调性。

关键词: font-size:medium, ">儿童步行功能；痉挛型脑瘫；核心肌群针刺；表面肌电信号

Abstract: Objective：To observe the effect of core muscle acupuncture on walking function and surface electromyography(sEMG) of lower limb in children with spastic cerebral palsy. Methods: A total of 51 children with spastic cerebral palsy who met the research requirements were randomly divided into the comprehensive rehabilitation group(25 cases) and the core acupuncture group(26 cases). Both groups were treated with comprehensive rehabilitation, and the core acupuncture group was treated with core muscle acupuncture. The scores of D and E areas in gross motor function measure(GMFM-88), integrated electromyography(iEMG) of gastrocnemius and tibialis anterior muscle and co-contraction ratio(CR) were used as the main observation indexes. Results: After treatment, the scores of area D and E of GMFM-88 in the two groups were higher than those before treatment(P<0.05), and the score of the core acupuncture group was higher than that of the comprehensive rehabilitation group(P<0.05). After treatment, under active activity, the iEMG of gastrocnemius muscle and anterior tibial muscle in the two groups were higher than those before treatment(P<0.01), and the increase was more obvious in the core acupuncture group(P<0.05). Under passive activity, the iEMG of gastrocnemius muscle and anterior tibial muscle in the two groups were lower than those before treatment(P<0.01), and the decrease was more obvious in the core acupuncture group(P<0.05). After treatment, the CR of gastrocnemius muscle and anterior tibial muscle in the two groups were lower than those before treatment(P<0.05), and the decrease was more obvious in the core acupuncture group(P<0.05). Conclusion:Core muscle acupuncture can effectively improve the standing balance and walking motor function of children with spastic cerebral palsy, improve the muscle strength of gastrocnemius and anterior tibial muscle, reduce their muscle tension, and improve the contraction coordination of active muscle and antagonistic muscle.

Key words: Children′s walking function;Spastic cerebral palsy, Core muscle acupuncture;Surface electromyography

中图分类号:

何婷, 张洁, 刘延萍, 陈素巧, 林栋. 针刺核心肌群对痉挛型脑瘫儿童步行功能及下肢表面肌电的影响[J]. 中国医药导刊, 2021, 23(12): 881-886.

HE Ting, ZHANG Jie , LIU Yanping, CHEN Suqiao, LIN Dong. Effects of Core Muscle Acupuncture on Walking Function and sEMG of Lower Limbs in Children with Spastic Cerebral Palsy[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2021, 23(12): 881-886.

参考文献

[1]中国康复医学会儿童康复专业委员会,中国残疾人康复协会小儿脑性瘫痪康复专业委员会,《中国脑性瘫痪康复指南》编委会.中国脑性瘫痪康复指南(2015):第一部分[J].中国康复医学杂志,2015,30(7):747-754.
     [2]Streja E, Miller JE, Wu C, et al.Disproportionate fetal growth and the risk for congenital cerebral palsy in singleton births[J].PLoS One,2015,10(5):e0126743.
     [3]张洁,刘延萍,洪营东,等.核心肌群针刺对痉挛型脑瘫患儿站立平衡的影响[J].亚太传统医药,2020,16(8):112-115.
     [4]马融.中医临床诊疗指南释义:儿科疾病分册[M].北京:中国中医药出版社,2015:134-137.
     [5]严晓华,何璐,郑韵,等.改良Ashworth量表与改良Tardieu量表在痉挛型脑瘫患儿评定中的信度研究[J].中国康复医学杂志,2015,30(1):18-21.
     [6]史惟,廖元贵,杨红,等.粗大运动功能测试量表与Peabody粗大运动发育量表在脑性瘫痪康复疗效评估中的应用[J].中国康复理论与实践,2004,10(7):43-44.
     [7]许萍,梁雷超,梁贞文,等.脑瘫尖足患儿站立和行走中下肢肌肉的表面肌电图[J].中国组织工程研究,2020,24(23):3673-3677.
     [8]李小萍,邹碧花,王诚婷.核心稳定力量训练对脑瘫患儿步行能力影响的临床研究[J].白求恩医学杂志,2015,13(6):613-614.
     [9]解清云,侯梅,赵建慧,等.核心稳定训练对痉挛型脑性瘫痪患儿运动功能的影响[J].中国康复医学杂志,2014,29(6):528-532.
     [10]齐腾澈,王春南.揿针按压疗法对脑瘫患儿核心肌群稳定性影响的临床对比研究[J].中国针灸,2018,38(6):597-601.
     [11]贺文华,董晓慧,汤臣建,等.“宗筋主束骨而利机关”理论在经筋病中的临床应用概况[J].湖南中医杂志,2019,5(35):155-157.
     [12]谢娇,吴安林,杨程,等.论中医经筋学说与肌筋膜链理论的关联性[J].湖南中医杂志,2019,35(4):113-114.
     [13]郑蒙,俞晓飞.经筋理论对中风后痉挛性偏瘫的临床指导意义[J].上海中医药杂志,2021,55(1):39-42.
     [14]Anne SC, Woollacott MH.运动控制原理与实践[M].北京:人民卫生出版社,2009:4-7.
     [15]杜雪晶,张通,刘元旻,等.超声视觉反馈下的核心训练对脑卒中偏瘫患者腹横肌厚度及运动功能的影响[J].中国康复,2021,3(36):135-139.
     [16]李初阳,史惟,周美琴,等.脑瘫粗大运动功能分级系统修订扩展版(中文版)的信度和效度研究[J].中国康复理论与实践,2011,17(12):1112-1115.
     [17]史惟,朱默,翟淳,等.基于ICF-CY的脑瘫粗大运动功能测试量表内容效度分析[J].中国康复理论与实践,2013,19(1):13-18.
     [18]Takahashi H,Seki M,Liu M.Evaluating motor function for pediatric rehabilitation with gross motor function measure(GMFM) : a review[J].The Japanese Journal of Rehabilitation Medicine,2005,42:475-488.
     [19]王绮,肖农,任永平,等.婴幼儿脑性瘫痪粗大运动功能评价量表信度与效度研究[J].重庆医学,2011,40(26):2643-2644.
     [20]李建华,王健.表面肌电图诊断技术临床应用[M].杭州:浙江大学出版社,2015:3.
     [21]曾杰,卫霄青,徐晓杰,等.表面肌电信号与脑瘫患儿肌力、肌张力间的相关性分析[J].中华物理医学与康复杂志,2017,39(9):704-705.
     [22]谢羽婕,张驰,胥方元,等.核心稳定性训练结合神经发育疗法对脑卒中患者下肢运动功能的影响[J].中国康复医学杂志,2014,29(8):773-775.
     [23]王雯,王毅,胡智海,等.核心稳定训练对脑卒中后偏瘫患者平衡功能的影响[J].中国中医药现代远程教育,2020,13(18):89-92.
     [24]高学生,张婷婷,付海燕,等.早期核心稳定性训练介入时机对脑卒中患者步行功能的影响[J].中国康复,2014,29(5):353-355.
     [25]Seong-Hun Y,Seong-Doo P.The effects of core stability strength exercise on muscle activity and trunk impairment scale in stroke patients.J].J Exerc Rehabil,2013,9(3):362-367.
     [26]高春华,黄晓琳,张威,等.核心稳定性训练对社区脑卒中患者下肢运动功能的作用[J].卒中与神经疾病,2014,21(4):207-211.

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