| ObjectiveThe research hopes to observe the clinical efficacy of electroacupuncture in the treatment of upper limb dysfunction in patients with cervical spinal cord injury.Diffusion tensor imaging(DTI)was used to evaluate the changes of nerve fiber tracts before and after electroacupuncture treatment,and to explore the correlation between DTI index,interational standards for neurological and functional classification of spinal cord injury(ASIA)and modified barthel index(MBI),so as to provide an objective evaluation index for electroacupuncture treatment of cervical spinal cord injury.MethodsThis study was designed by a randomized controlled trial.In this study,46 patients with incomplete cervical spinal cord injury caused by trauma or non-traumatic injuries were randomly divided into the observation group(n=23)and the control group(n=23).Both groups were treated with neurosurgery(surgery+drugs)and rehabilitation.The observation group started electroacupuncture treatment on the basis of 7 days after the suture removal,acupointed at "governor vessel" "’jiaji" "quchi" "waiguan" "hegu" points,Wave type continuous wave,frequency 2HZ,stimulation intensity based on patient tolerance,1/day,30min/time,5 days/week,3 months of treatment respectively.All patients were evaluated by cervical DTI examination and the sensory and motor scores of the spinal ASIA upper limb and MBI scores before and after treatment.DTI,ASIA scores and MBI scores were performed on the same day.At the same time,when the patient was admitted to the hospital,we selected two groups of healthy people of similar age as health groups from the physical examination center of our hospital,also on the same day for cervical DTI examination,healthy group had only one DTI scan.The Syngo Via post-processing software of Siemens 3.0T was used for data processing and image reconstruction.The cervical spinal cord was divided into two areas:the injury area and the distal end of the injury area,measuring the levels nof Cl～C7 in the three group FA and ADC value,then calculating the average of the above two areas.We compared the differences in DTI and ASIA scores between the observation group and the control group before and after treatment,and discussed the correlation between the ASIA upper limb sensation and exercise scores and MBI scores and the DTI index in the observation group and the change of the fiber tracts ratio(FT)before the treatment and the relationship between recovery of upper extremity motor function and cervical spinal cord injury after treatment.Results1.Before treatment,the FA values of the observation group and the control group was lower than that of the healthy group(P<0.05),and the ADC values was higher than that of the healthy group(P<0.05).The FA values of the observation group and the control group in the injury area was significantly lower than the distal end of the injury area(P<0.05),but there was no significant difference in the ADC values between the lesion area and the distal end of the lesion(P>0.05).There was no significant difference in FA and ADC values between the two groups in the healthy group(P>0.05).Diffusion tensor tomography(DTT)images reconstructed by normal subjects showed that the fiber tracts were plump and smooth,and the DTT images of patients with cervical spinal cord injuries showed that the fiber tracts were compressed,displaced,or even interrupted.2.Before treatment,there was no significant difference in FA values and ADC values between the observation group and the control group in the two regions of the cervical spinal cord(P>0.05).After 3 months of treatment,there was no significant difference between the FA and ADC values in the two groups(P>0.05),but there was an improvement trend in the observation group compared with the control group.3.the observation group ASIA upper limb sensation scores(41.7±15.4),ASIA upper limb exercise scores(32.2± 13.8)and MBI scores(51.4±25.8)were all improved after treatment(57.7± 13.3,42.6±9.6,86.5± 17.2,).the control group ASIA upper limb sensory scores(42.6 ±11.7),ASIA upper limb movement scores(31.8 ± 12.6),MBI scores(50.8 ± 23.2)were improved after treatment(50.8 ± 9.3,36.0 ± 11.8,72.6 ± 15.2),while the scores of the above observation group increased more than the control group(P<0.05).4.Before treatment,the FA values in the injury area and injury area was positive correlated with ASIA upper limb sensory scores(r=0.414,0.326,P<0.05),upper limb movement score s(r=0.457,0.379,P<0.05),and MBI scores(r=0.356,0.370,P<0.05).There was no correlation between ADC values and ASIA upper limb sensation scorse,exercise scores and MBI scores(P>0.05).5.The pre-FT ratio in the observation was significantly associated with the recovery of upper extremity motor function after treatment(r=0.733,P<0.001),the FT ratio at the lesion before treatment was>60.0%,electroacupuncture combined with surgery,drugs,rehabilitation.In 69.2%of the patients,the recovery rate of upper limb motor function was up to 100.0%after 3 months of treatment.Conclusions1.Electroacupuncture combined with rehabilitation training plays a significant role in promoting the recovery of upper extremity sensory and motor function in patients with cervical spinal cord injury,and can further improve the ability of patients with daily life.2.DTT can clearly show the morphological changes of the fiber tracts after cervical spinal cord injury,and it plays an important role in the evaluation of the clinical and rehabilitation effects of patients with cervical spinal cord injury and in predicting the prognosis of spinal cord function. |
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