針灸治療在小動物癱瘓之研究

Abstract

臨床獸醫師經常遇到犬隻脊椎疾病引起癱瘓的病例，癱瘓的原因歸類為脊髓壓迫性與非壓迫性。壓迫性原因諸如椎間盤突出、脊椎脫位、脊椎關節粘連等，非壓迫性原因諸如脊髓栓塞等。治療分為保守治療與侵入治療二大類，嚴重結構性壓迫者必須進行手術矯正，有些病例靠針灸治療反應良好，由於種種考量，甚至靠針灸治療此類癱瘓疾病有增加之趨勢。針灸治療包括穴位的選擇，刺激方式的差異大。本研究目的在於評估以新的簡化針灸穴位組合及標準化針灸方式，合併中藥治療，應用於四肢癱瘓與後軀癱瘓的療效。四肢癱瘓治療方面，近端取穴採用頸夾脊穴，遠端取穴前肢採用合谷穴、後溪穴及後肢太衝穴，依癱瘓嚴重程度給予乾針或電針刺激，分為三等級治療。經統計分析，應用新方法治療，療效良好，適合中老年四肢癱瘓犬隻，其中復原時間以電針刺激較乾針刺激長。後軀癱瘓治療方面，84頭臨床就診犬隻，分為非手術及減壓手術後二大類，應用背部華佗夾脊穴為近端取穴，遠端取穴則為環跳穴、陽陵泉穴、 合谷穴、太衝穴，依癱瘓嚴重程度給予乾針或電針刺激，分為四等級治療。經統計分析，應用新方法治療，療效良好，成功率分別為95%與74%其中乾針與電針刺激無顯著療效差異。結論為，此新創針灸治療方法經過大量臨床病例驗證有效，簡要且易操作值得臨床獸醫師使用。

Cases of spinal cord diseases which cause paresis are commonly encountered by canine practitioners. The causes are structural compression such as intervertebral disc disease (IVDD), vertebral dislocation, spondylosis, or non-structural compression such as fibrocartilaginous embolism. Conservative intervention and surgery are the two main treatment modalities. Cases of severe structural compression require surgery. Certain others are responsive to acupuncture treatment. There is an increasing tendency to use acupuncture as an alternate treatment due to its less invasive character and its effectiveness in certain cases. The purpose of this study was to evaluate new acupuncture protocols for the clinical treatment of cervical spinal cord diseases in dogs. A new standardized protocol of three options comprised mainly of the Jing-jiaji, SI3, LI4, LIV3 acupoints was performed. These options consisted of gradual treatment with dry needle acupuncture (AP) and electro-acupuncture (EAP) applied to cervical spinal cord area depending on the disease severity. Three treatment options were developed to treat neck pain, hemiparesis, and tetraparesis depending on the severity. The interval between the neurological disease onset and treatment (duration of signs), time to improvement after treatment, and recovery time were compared in the dogs by body weight, age, and dry needle acupuncture (AP) with or without electro-AP (EAP). The improvement and recovery times were longer in the AP+EAP group compared to AP group (p < 0.05). Acupuncture with Jing-jiaji was effective in cervical spinal cord diseases in different sized dogs and in middle-aged and senior dogs. This report standardized AP treatment for canine cervical problems and evaluated its effects. This study also was conducted in 84 dogs with thoracolumbar spinal cord diseases of different breeds divided into two main groups: the non-surgery (n=65) and post-intervertebral disc disease (IVDD) surgery (n=19) groups, which were referred to our practice for TCVM treatment due to thoracolumbar spinal cord disease. A new standardized protocol of four options comprised mainly of the Hua-tuo-jiaji (HTJJ), GB30, GB34, LIV3, LI4 acupoints plus Chinese herbal medicine was performed. These options consisted of gradual treatment with dry needle acupuncture (AP) and electro-acupuncture (EAP) applied to the thoracolumbar spinal cord area depending on the disease severity. Duration of sign, improvement time, and recovery time were recorded. In the non-surgery group, the success rate was 95%. The mean improvement time was 13.1 days, the average number of acupuncture sessions was 4 while the mean recovery time was 27.5 days, with 6.5 sessions. In the post-IVDD surgery group, good outcomes were achieved in 74% of the dogs. The mean improvement time was 18.6 days, with an average of 6.1 sessions while the mean recovery time was 53 days, with an average of 11.6 sessions. There was no significant statistical difference between AP and EAP in the efficacy without breed predisposition and the severity impacted the prognosis. We concluded that the newly standardized AP methodology offers clinical practitioners an effective way to improve the outcomes of cervical and thoracolumbar spinal cord diseases in dogs. These new acupuncture methods had favorable efficacy in clinical cases.