中西医结合治疗婴儿先天性肌性斜颈的效果

doi:10.3969/j.issn.1006-9771.2020.08.005

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (8): 897-902.doi: 10.3969/j.issn.1006-9771.2020.08.005

中西医结合治疗婴儿先天性肌性斜颈的效果

杨晓颜¹,周璇¹,毛琳¹,陈荣霞²,靳梦蝶¹,夏义玲¹,王姗姗¹,汪德轩¹,杜青^1,³()

1.上海交通大学医学院附属新华医院康复医学科,上海市 200092
2.北京卫戍区海淀第五十一离职干部休养所门诊部,北京市 100142
3.上海交通大学医学院附属新华医院崇明分院,上海市 202150

收稿日期:2020-06-10 修回日期:2020-07-06 出版日期:2020-08-25 发布日期:2020-08-31
通讯作者: 杜青 E-mail:duqing@xinhuamed.com.cn
作者简介:杨晓颜(1979-),女,汉族,江苏南通市人,硕士,主治医师,主要研究方向：儿童康复、神经康复。
基金资助:
1.上海市进一步加快中医药事业发展三年行动计划(ZY(2018-2020)-FWTX-8006);2.崇明区医学重点专科项目

Effect of Integrative Medicine on Infant with Congenital Muscular Torticollis

YANG Xiao-yan¹,ZHOU Xuan¹,MAO Lin¹,CHEN Rong-xia²,JIN Meng-die¹,XIA Yi-ling¹,WANG Shan-shan¹,WANG De-xuan¹,DU Qing^1,³()

1. Department of Rehabilitation Medicine, Xinhua Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai 200092, China
2. Outpatient Department of the 51st Retired Cadre Retreat, Beijing 100142, China
3. Chongming Branch of Xinhua Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai 202150, China

Received:2020-06-10 Revised:2020-07-06 Published:2020-08-25 Online:2020-08-31
Contact: DU Qing E-mail:duqing@xinhuamed.com.cn
Supported by:
Three-year (2018-2020) Action Plan to Further Accelerate the Development of Traditional Chinese Medicine of Shanghai(ZY(2018-2020)-FWTX-8006);Key Specialist Medical Project of Chongming District

摘要/Abstract

摘要：

目的观察中西医结合治疗对先天性肌性斜颈患儿的效果。方法回顾性选择2017年10月至2019年9月在本院进行治疗的先天性肌性斜颈患儿80例,根据治疗方案分为治疗组1 (n = 40)和治疗组2 (n = 40)。治疗组1进行综合物理疗法,包括被动牵伸、头控训练、姿势矫正和家庭康复。治疗组2在此基础上增加中医推拿手法。比较两组治疗前及治疗6个月后仰卧中立位、颈部旋转和拉伸时双侧胸锁乳突肌的表面肌电信号均方根值(RMS),颈部被动旋转与侧屈的活动度以及头部偏离中线向患侧歪斜的角度。结果治疗前,两组中立位、颈部旋转和拉伸时,患侧胸锁乳突肌RMS均低于健侧(P < 0.01),颈部向健侧侧屈、向患侧旋转的活动度明显小于对侧( P < 0.01),但两组间均无显著性差异( P > 0.05)。治疗后,两组各体位下,患侧胸锁乳突肌RMS,颈部向患侧旋转、向健侧侧屈的活动度均较治疗前明显改善(| t| > 3.290, P < 0.01),且治疗组2均优于治疗组1 ( t > 2.401, P < 0.05)。治疗后,两组头部偏离中线向患侧歪斜的角度均显著减小( t > 15.075, P < 0.001),且治疗组2显著小于治疗组1 ( t = -4.971, P < 0.001)。结论中医推拿结合综合物理疗法治疗婴儿先天性肌性斜颈优于单纯综合物理疗法。

关键词: 先天性肌性斜颈, 推拿, 表面肌电图

Abstract:

Objective To study the efficacy of integrative medicine on congenital muscular torticollis.Methods From October, 2017 to September, 2019, 80 children with congenital muscular torticollis were divided into group 1 (n = 40) and group 2 (n = 40) according to different treatment schemes. Group 1 received comprehensive physiotherapy, including passive stretching, head control training, posture correction and family rehabilitation. Group 2 received Tuina in addition. Before and six months after treatment, the root mean square (RMS) of surface electromyography of bilateral sternocleidomastoid muscles in supine neutral position, neck rotation and stretch, and the range of motion of passive neck rotation and lateral flexion, and the angle of head deviation from the midline to the affected side were compared.Results Before treatment, the RMS of sternocleidomastoid muscle in each position was lower in the affected side than in the healthy side (P < 0.01), and the range of motion of neck when lateral flexion to the healthy side and rotation to the affected side was less than that of the other side ( P < 0.01) in both groups; however, no significant difference was found between two groups ( P > 0.05). After treatment, the RMS of EMG of sternocleidomastoid muscle in each position, and the range of motion of neck when lateral flexion to the healthy side and rotation to the affected side improved (| t| > 3.290, P < 0.01) in both groups, and were better in group 2 than in group 1 ( t > 2.401, P < 0.05); the angle of head deviation from the midline to the affected side significantly decreaed ( t > 15.075, P < 0.001) in both groups, and was significantly less in group 2 than in group 1 ( t = -4.971, P < 0.001). Conclusion Integrative medicine is effective on infant with congenital muscular torticollis, which is superior to comprehensive physiotherapy only.

Key words: congenital muscular torticollis, Tuina, surface electromyography

中图分类号:

R726.8

杨晓颜,周璇,毛琳,陈荣霞,靳梦蝶,夏义玲,王姗姗,汪德轩,杜青. 中西医结合治疗婴儿先天性肌性斜颈的效果[J]. 《中国康复理论与实践》, 2020, 26(8): 897-902.

YANG Xiao-yan,ZHOU Xuan,MAO Lin,CHEN Rong-xia,JIN Meng-die,XIA Yi-ling,WANG Shan-shan,WANG De-xuan,DU Qing. Effect of Integrative Medicine on Infant with Congenital Muscular Torticollis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(8): 897-902.

图/表 4

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组别	n	男/女(n)	年龄(d)
治疗组1	40	29/11	54.55±34.24
治疗组2	40	25/15	53.18±27.35
χ²/t值		0.912	0.204
P值		0.340	0.840

组别	时间	n	中立位健侧	中立位患侧	向患侧旋转时健侧	向健侧旋转时患侧	向患侧拉伸时健侧	向健侧拉伸时患侧
治疗组1	治疗前	40	18.39±4.80	9.58±3.97^e	39.58±13.98	24.12±10.97^e	35.39±13.45	19.23±9.67^e
	治疗后	40	17.24±3.74	14.41±2.64	38.50±12.45	31.00±8.88	34.99±9.86	28.24±6.74
治疗组2	治疗前	40	18.38±3.48	9.16±3.68^e	37.56±14.31	22.28±9.06^e	36.94±11.19	21.22±9.84^e
	治疗后	40	17.32±4.27	16.14±3.53	39.79±11.93	36.30±10.80	35.31±10.7	32.60±8.43
	t值^a		1.371	-8.395	-0.695	-6.501	0.613	-5.436
	P值^a		0.178	< 0.001	0.491	< 0.001	0.544	< 0.001
	t值^b		1.069	-5.571	0.470	-3.290	0.150	-5.097
	P值^b		0.292	< 0.001	0.641	0.002	0.881	< 0.001
	t值^c		-0.012	-0.496	-0.639	-0.817	0.560	0.913
	P值^c		0.349	0.588	0.774	0.410	0.577	0.364
	t值^d		0.088	2.475	0.472	2.401	0.139	2.551
	P值^d		0.139	0.012	0.934	0.019	0.890	0.013

组别		n	向患侧侧屈	向健侧侧屈	向健侧旋转	向患侧旋转
治疗组1	治疗前	40	70.25±4.07	39.38±10.87^e	72.75±5.30	32.88±6.78^e
	治疗后	40	69.62±3.99	58.75±7.14	73.63±5.55	59.13±7.24
治疗组2	治疗前	40	69.75±4.23	39.88±10.59^e	73.5±4.96	35.38±5.82^e
	治疗后	40	70.00±3.92	65.13±8.05	71.00±4.70	62.38±6.00
	t值^a		-0.280	-13.271	1.936	-25.206
	P值^a		0.781	< 0.001	0.060	< 0.001
	t值^b		0.725	-10.357	0.107	-16.022
	P值^b		0.473	< 0.001	0.915	< 0.001
	t值^c		-0.538	0.208	0.653	1.770
	P值^c		0.592	0.835	0.516	0.081
	t值^d		0.424	3.749	-1.414	2.187
	P值^d		0.673	< 0.001	0.161	0.032

组别	n	治疗前	治疗后	t值	P值
治疗组1	40	14.8±3.15	5.85±2.01	19.951	< 0.001
治疗组2	40	14.58±2.97	3.63±2.00	15.075	< 0.001
t值		-0.328	-4.971
P值		0.744	< 0.001

中西医结合治疗婴儿先天性肌性斜颈的效果

Effect of Integrative Medicine on Infant with Congenital Muscular Torticollis

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