推拿联合局部注射糖皮质激素治疗小儿先天性斜颈的效果及对彩超结果的影响
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摘要
目的探讨推拿联合局部注射糖皮质激素治疗小儿先天性斜颈的效果及对彩超结果的影响。方法以2015年5月至2017年4月进入本院门诊的150例于先天性斜颈患儿作为研究对象,按电脑数字表法随机分作3组,各50例,A组施予推拿治疗,B组施予局部注射糖皮质激素治疗,C组施予推拿联合局部注射糖皮质激素治疗,回顾性分析3组疗效及其彩超结果。结果治疗后C组优良率高于A组和B组,差异有统计学意义(P<0.05);治疗开始后第2、4、6、8、10、12月时随访发现,3组肿块厚度及其胸锁乳突肌的挛缩长度与治疗前比较差异有统计学意义(P<0.05);且组内在各随访时间点与之前各时间点比较,差异均有统计学意义(P<0.05);此外,在各随访时间点,A、B两组比较差异无统计学意义(P>0.05),但C组与A、B两组比较差异有统计学意义(P<0.05)。结论推拿联合局部注射糖皮质激素治疗小儿先天性斜颈可提升疗效,有助于缩短肿块厚度及其胸锁乳突肌的挛缩长度,值得临床推广。
Objective To analyze the efficacy of massage combined with local injection of glucocorticoid in the treatment of congenital muscular torticollis in children and its impact on color Doppler ultrasound results. Methods A total of 150 children with congenital muscular torticollis, who visited the outpatient department of our hospital from May 2015 to April 2017, were enrolled as subjects and equally divided into three groups using a computer-generated random number table. Group A was treated with massage. Group B received local injection of glucocorticoid. Group C received massage combined with local injection of glucocorticoid. A retrospective analysis was performed on the clinical outcomes and color Doppler ultrasound results in the three groups. Results After treatment, group C had a significantly higher response rate than group A and group B(96.00% vs78.00%/76.00%, P<0.05). During the follow-up at 2, 4, 6, 8, 10, and 12 months after treatment, the mass thickness and contracture length of the sternocleidomastoid(SCM) muscle were significantly reduced in the three groups(P<0.05); the mass thickness and contracture length of the SCM muscle at each time point were significantly larger than those at following time points(P<0.05).Conclusion Massage combined with local injection of glucocorticoid can improve the treatment outcomes and reduce mass thickness and contracture length of the SCM muscle in children with congenital muscular torticollis, which holds promise for clinical application.
Objective To analyze the efficacy of massage combined with local injection of glucocorticoid in the treatment of congenital muscular torticollis in children and its impact on color Doppler ultrasound results. Methods A total of 150 children with congenital muscular torticollis, who visited the outpatient department of our hospital from May 2015 to April 2017, were enrolled as subjects and equally divided into three groups using a computer-generated random number table. Group A was treated with massage. Group B received local injection of glucocorticoid. Group C received massage combined with local injection of glucocorticoid. A retrospective analysis was performed on the clinical outcomes and color Doppler ultrasound results in the three groups. Results After treatment, group C had a significantly higher response rate than group A and group B(96.00% vs78.00%/76.00%, P<0.05). During the follow-up at 2, 4, 6, 8, 10, and 12 months after treatment, the mass thickness and contracture length of the sternocleidomastoid(SCM) muscle were significantly reduced in the three groups(P<0.05); the mass thickness and contracture length of the SCM muscle at each time point were significantly larger than those at following time points(P<0.05).Conclusion Massage combined with local injection of glucocorticoid can improve the treatment outcomes and reduce mass thickness and contracture length of the SCM muscle in children with congenital muscular torticollis, which holds promise for clinical application.
引文
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[12]张健,刘东博,赵澎.以中医推拿为主要手段治疗小儿肌性斜颈的概况及临床体会[J].天津中医药,2017,34(4):285-288.
[13]刘慧,张喜林,沈国权,等.沈国权基于中医整体观推拿治疗先天性肌性斜颈经验[J].中华中医药杂志,2017,32(9):4035-4037.
[14] HE L, YAN X, LI J, et al. Comparison of 2 Dosages of Stretching Treatment in Infants with Congenital Muscular Torticollis:A Randomized Trial[J]. American Journal of Physical Medicine&Rehabilitation, 2016,96(5):333-340.
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[16]马柯.糖皮质激素在疼痛微创介入治疗中的应用———中国专家共识[J].中国疼痛医学杂志,2017,23(6):401-404.
[17]李必保.推拿联合针灸对椎动脉型颈椎病患者的症状体征总积分和椎动脉血流状态的影响[J].湖南中医药大学学报,2016,36(9):82-85.
[18] HUSSEIN M A, YUN I S, PARK H, et al. Cervical Spine Deformity in Long-Standing, Untreated Congenital Muscular Torticollis[J]. Journal of Craniofacial Surgery, 2017,28(1):46.
[19]谈芝含,武心萍,丁文波,等.超声弹性成像技术在手法推拿治疗小儿先天性肌斜颈中的应用价值[J].现代医学,2017,45(5):644-646.
[2]王娟,唐毅.先天性肌性斜颈影像学表现的研究进展[J].中国介入影像与治疗学,2016,13(8):510-513.
[3]王成,李楠.推拿结合膏摩治疗对不同年龄段先天性肌性斜颈患儿的临床疗效[J].陕西中医,2016,37(10):1303-1304.
[4]李正.实用小儿外科学[M].北京:人民卫生出版社,2001.
[5]于天源.推拿学[M].北京:中国医药科技出版社,2013.
[6]孙传兴.临床疾病诊断依据治愈好转标准[M].2版.北京:人民军医出版社,1998.
[7]姚嵩梅,张耀中,薛均来,等.推拿治疗先天性小儿肌性斜颈[J].长春中医药大学学报,2016,32(3):576-578.
[8]张业宗.吴鞠通《解儿难》初探[J].吉林中医药,1987,4(4):40-41.
[9]程永,王竹行,唐成林,等.经筋病中医病理机制理论探讨[J].辽宁中医药大学学报,2014,16(6):101-108.
[10]沙晓溪,张嬿,彭趣思,等.中医推拿治疗小儿先天性肌性斜颈的超声客观化评价[J].中国超声医学杂志,2016,32(7):577-579.
[11]张德文,刘正全,唐盛平,等.局部注射治疗婴儿先天性肌性斜颈380例疗效观察[J].中国组织工程研究,2001,5(3):61.
[12]张健,刘东博,赵澎.以中医推拿为主要手段治疗小儿肌性斜颈的概况及临床体会[J].天津中医药,2017,34(4):285-288.
[13]刘慧,张喜林,沈国权,等.沈国权基于中医整体观推拿治疗先天性肌性斜颈经验[J].中华中医药杂志,2017,32(9):4035-4037.
[14] HE L, YAN X, LI J, et al. Comparison of 2 Dosages of Stretching Treatment in Infants with Congenital Muscular Torticollis:A Randomized Trial[J]. American Journal of Physical Medicine&Rehabilitation, 2016,96(5):333-340.
[15] KENYON C J, PANARELLI M, ZAGATO L, et al. Glucocorticoid receptor polymorphism in genetic hypertensio n[J]. Journal of Molecular Endocrinology,2016,21(1):41-50.
[16]马柯.糖皮质激素在疼痛微创介入治疗中的应用———中国专家共识[J].中国疼痛医学杂志,2017,23(6):401-404.
[17]李必保.推拿联合针灸对椎动脉型颈椎病患者的症状体征总积分和椎动脉血流状态的影响[J].湖南中医药大学学报,2016,36(9):82-85.
[18] HUSSEIN M A, YUN I S, PARK H, et al. Cervical Spine Deformity in Long-Standing, Untreated Congenital Muscular Torticollis[J]. Journal of Craniofacial Surgery, 2017,28(1):46.
[19]谈芝含,武心萍,丁文波,等.超声弹性成像技术在手法推拿治疗小儿先天性肌斜颈中的应用价值[J].现代医学,2017,45(5):644-646.