Acupuncture therapy based on intramuscular nerve distribution combined with routine rehabilitation exercise training for the treatment of spastic cerebral palsy with tip foot deformity

doi:10.3877/cma.j.issn.1673-5250.2018.06.012

Objective

To study the clinical efficacy of the degree of spasm and gross motor function of acupuncture therapy based on intramuscular nerve distribution combined with routine rehabilitation exercise training for treatment of tip foot deformity in children with spastic cerebral palsy (CP).

Methods

From July 2013 to November 2016, a total of 47 children with spastic CP tip foot deformity who were treated in the Department of Rehabilitation, Chengdu Women′s and Children′s Central Hospital, were selected as research subjects. Using random number table method, they were divided into observation group (n=24) and control group (n=23). Both groups were treated by the same routine rehabilitation exercise training and traditional Chinese medicine massage, meanwhile the observation group were taken additional acupuncture therapy based on intramuscular nerve distribution, and all the children were treated for 6 months. Before treatment, and after treatment of 1, 3, 6 months, curative effect of CP children were evaluate by the Gross Motor Function Measure Scale (GMFM) and Composite Spasticity Scale (CSS). The general clinical data between two groups of children, also the evaluation results of curative effect at different time points before and after treatment between two groups and intra group were compared by t test and chi-square test for statistical analysis. The procedure followed in this study were in lined with the ethical standards formulated by the Ethics Committee of Chengdu Women′s and Children′s Central Hospital, and has been approved by this committee [approval number: 2015 (11)]. All guardians of children signed the informed consents of clinical research.

Results

①There were no significant differences between two groups of children in gender constituent ratio of male and female, age, and grade constituent ratio of grade Ⅱ and Ⅲ of gross motor function grading system (GMFCS) (P>0.05). ②Comparison results of CSS and GMFM scores between two groups: there were no significant differences between two groups in CSS and GMFM scores before treatment (P>0.05). The CSS scores at 1, 3, 6 months after treatment in observation group were (10.5±1.9) sores, (7.6±1.7) sores and (7.0±1.5) sores, respectively, which were lower than those of (11.9±1.7) sores, (8.6±1.6) sores and (8.2±1.8) sores, respectively in control group; the GMFM scores at 1, 3, 6 months after treatment in observation group were (66.7±9.5) sores, (79.6±10.1) sores and (90.2±10.9) sores, respectively, which were higher than those of (49.1±8.8) sores, (73.1±11.2) sores and (81.5±12.6) sores, respectively in control group, and the differences were all statistically significant (CSS score: t=-2.662, P=0.011; t=-2.022, P=0.049; t=-2.374, P=0.022. GMFM score: t=6.588, P<0.001; t=2.086, P=0.043; t=2.532, P=0.015). ③Comparison results of CSS and GMFM scores of intra group: the CSS scores at 1, 3, 6 months after treatment were lower than that of before treatment′s (12.1±1.7) scores, respectively, the GMFM scores were higher than that of before treatment′s (49.5±7.9) scores, respectively in observation group, and the differences were statistically significant (t=-11.632, -26.432, -32.111; t=9.091, 14.159, 17.352; all P<0.001). There were no significant differences in CSS and GMFM scores between 1 months after treatment and before treatment in control group (P>0.05). The CSS scores at 3, 6 months after treatment were lower than that of before treatment′s (12.0±1.6) scores, respectively, while the GMFM scores were higher than that of before treatment′s (48.5±8.5) scores, respectively in control group, and the differences were statistically significant (t=-18.247, -17.109; t=10.366, 11.723; all P<0.001).

Conclusions

Through the basis of routine rehabilitation exercise training of gross motor function and massage therapy of traditional Chinese medicine, and combined with acupuncture therapy based on intramuscular nerve distribution, those treatment strategies for spastic CP tip foot deformity took effect earlier, which can further alleviate limbs spasm, alleviate abnormal posture of lower limb toes and improve motor function of lower limbs.

Key words: Cerebral palsy, Muscle spasticity, Equinus deformity, Acupuncture therapy, Peroneal nerve, Tibial nerve, Child

图2 胫神经刺激点位置示意图

表1 2组患儿一般临床资料比较

组别	例数	性别[例数(%)]		年龄(月，±s)	GMFCS分级[例数(%)]
组别	例数	男	女	年龄(月，±s)	Ⅱ级	Ⅲ级
观察组	24	14(58.3)	10(41.7)	41.2±18.1	9(37.5)	15(62.5)
对照组	23	11(47.8)	12(52.2)	40.1±12.7	8(34.8)	15(65.2)
检验值	?	χ²＝0.521		t＝0.303	χ²＝0.038
P值	?	0.471		0.764	0.846

表1 2组患儿一般临床资料比较

组别	例数	性别[例数(%)]		年龄(月，±s)	GMFCS分级[例数(%)]
组别	例数	男	女	年龄(月，±s)	Ⅱ级	Ⅲ级
观察组	24	14(58.3)	10(41.7)	41.2±18.1	9(37.5)	15(62.5)
对照组	23	11(47.8)	12(52.2)	40.1±12.7	8(34.8)	15(65.2)
检验值	?	χ²＝0.521		t＝0.303	χ²＝0.038
P值	?	0.471		0.764	0.846

表2 2组患儿治疗前、后不同时间点疗效评价结果组间及组内比较(分，±s)

组别	例数	CSS分值				GMFM分值(D、E区)
组别	例数	治疗前	治疗1个月	治疗3个月	治疗6个月	治疗前	治疗1个月	治疗3个月	治疗6个月
观察组	24	12.1±1.7	10.5±1.9	7.6±1.7	7.0±1.5	49.5±7.9	66.7±9.5	79.6±10.1	90.2±10.9
对照组	23	12.0±1.6	11.9±1.7	8.6±1.6	8.2±1.8	48.5±8.5	49.1±8.8	73.1±11.2	81.5±12.6
t值	?	0.262	－2.662	－2.022	－2.374	0.427	6.588	2.086	2.532
P值	?	0.795	0.011	0.049	0.022	0.671	<0.001	0.043	0.015

表2 2组患儿治疗前、后不同时间点疗效评价结果组间及组内比较(分，±s)

组别	例数	CSS分值				GMFM分值(D、E区)
组别	例数	治疗前	治疗1个月	治疗3个月	治疗6个月	治疗前	治疗1个月	治疗3个月	治疗6个月
观察组	24	12.1±1.7	10.5±1.9	7.6±1.7	7.0±1.5	49.5±7.9	66.7±9.5	79.6±10.1	90.2±10.9
对照组	23	12.0±1.6	11.9±1.7	8.6±1.6	8.2±1.8	48.5±8.5	49.1±8.8	73.1±11.2	81.5±12.6
t值	?	0.262	－2.662	－2.022	－2.374	0.427	6.588	2.086	2.532
P值	?	0.795	0.011	0.049	0.022	0.671	<0.001	0.043	0.015

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