精细化针灸治疗面瘫后遗症联带运动:随机对照试验OA

Objective To observe the effect of refined mode of acupuncture and moxibustion for synkinesia of facial paralysis sequelae based on surface electromyography(sEMG).Methods Sixty patients with synkinesia of facial paralysis sequelae were randomized into a special manipulation group and a basic manipulation group in a ratio of 1∶1,with 30 cases in each group.Acupoints such as Yangbai(GB14),Cuanzhu(BL2),Touwei(ST8)and Taiyang(EX-HN5)on the affected side,as well as bilateral Sibai(ST2),Quanliao(SI18)were selected in the two groups.Conventional acupuncture was applied in the basic manipulation group,while point-to-point needling with long needle,stuck needling by lifting and dragging,and balance needling on the healthy side were delivered in the special manipulation group.The needles were retained for 30 min,once every other day,3 times a week,for 30 sessions in total in the two groups.The Sunnybrook facial grading system(SFGS)score and the facial paralysis fine graduation scale grading were observed before and after treatment in the two groups;sEMG was performed before and after treatment,and the ratios of root mean square(RMS)on the affected side to the healthy one of frontalis,orbicularis oculi,buccinator,nasalis,orbicularis oris,and the integrated electromyography(IEMG)of orbicularis oculi were calculated;the correlation analysis was conducted between the total score of SFGS and facial paralysis fine graduation scale grading,and the clinical efficacy and safety were evaluated in the two groups.Results After treatment,the total scores of SFGS were increased and the synkinesia scores were decreased compared with those before treatment in both groups(P＜0.001);in the special manipulation group,the total score of SFGS was higher and the synkinesia score was lower than those in the basic manipulation group(P＜0.01,P＜0.05).After treatment,the ratios of RMS on the affected side to the healthy one of orbicularis oculi,nasalis and orbicularis oris were increased compared with those before treatment in the special manipulation group(P＜0.01,P＜0.001),and those of orbicularis oculi,buccinator and nasalis were increased compared with those before treatment in the basic manipulation group(P＜0.05,P＜0.01);in the special manipulation group,the ratio of RMS on the affected side to the healthy one of nasalis was higher than that in the basic manipulation group(P＜0.05).After treatment,the IEMG of orbicularis oculi was decreased compared with that before treatment in the two groups(P＜0.001),and the IEMG of orbicularis oculi in the special manipulation group was lower than that in the basic manipulation group(P＜0.05).After treatment,the grading of angulus oris drooping and eyelid closure was decreased compared with that before treatment in the two groups(P＜0.01,P＜0.05,P＜0.001),and the grading of angulus oris drooping and eyelid closure in the special manipulation group was lower than that in the basic manipulation group(P＜0.01,P＜0.05).The total score of SFGS was negatively correlated with the grading of angulus oris drooping and eyelid closure(P＜0.001).The total effective rate was 93.3%(28/30)in the special manipulation group,which was higher than 70.0%(21/30)in the basic manipulation group(P＜0.01).No adverse events occurred during the trial.Conclusion Refined mode of acupuncture and moxibustion contributes to the recovery of facial muscle strength,regulates oculofacial synkinesia,corrects angulus oris deviation and promotes eyelid closure in patients with synkinesia of facial paralysis sequelae.