針刺治療嬰兒臂神經叢麻痺

Acupuncture for Infantile Brachial Plexus Palsy

臂神經叢麻痺（brachial plexus palsy）是新生兒周圍神經損傷中最常見的一種。常見原因為臀位、肩難產等因素使臂神經叢過度牽拉導致受損。物理治療/復健、施打肉毒桿菌毒素與手術是目前現代醫學的主流療法。若沒有完全恢復或是即時施行手術，則可能產生因為肌肉的萎縮或肌張力不平衡造成骨頭發育不良的後遺症，但手術本身亦有其相關風險需注意。 本案例為一名七個月大的病童，自出生時家屬即發現左手不會動，只有手指有反應。針刺治療主要以治療受損患部之經絡及相關穴位為主（經脈所過，主治所及）1，並使用1寸針淺刺。在給予現代醫學藥物彌可保®、針刺與物理治療/復健療程同時進行下，針刺治療五個月後檢測神經傳導速度及肌電圖其回復進展顯著。可提供潛在神經輕度再生之證據。臨床症狀則於病童滿足歲又四個月（針刺治療55次）時觀察到病情有明顯改善。我們期望能提供另一種中西醫整合療法的思維與方法，以及評估將針刺與復健科的療程做一整合治療的可行性。

Brachial plexus palsy is one of the most common injury in neonatal peripheral nerve injury. Common causes for it are breech presentation, shoulder dystocia or other factors lead to excessive tractions on brachial plexus causing damage. Physical therapy / rehabilitation, Botulinum toxin injection and surgery are the main therapies in modern medicine. If there isn’t fully recovered or immediate implementation of surgery wasn’t done, the sequela will be muscle atrophy or bone dysplasia due to muscle tone imbalance. However surgery itself has its associated risks. This case showed a seven-month-old infant was found its left hand doesn’t move by its family, except for fingers reactions. Acupuncture therapy was targeted on the meridian around injured area and related acupuncture point (the positions where the meridians through should be the main therapeutic area), furthermore we used superficial acupuncture with 1-inch needle. After first treatment five months with dosing Methycobal®, doing the courses of physical therapy / rehabilitation and acupuncture therapy simultaneously, the progression of detecting nerve conduction velocity and EMG was good. It can provide the potential evidence of nerve mild regeneration. The clinical symptoms was observed significantly improvement while the infant was 1-year-and-four-month-old(after acupuncture therapy 55 times). We hope to provide another thinking process and method about the alternative therapy integrating Chinese and Western Medicine. And assess the feasibility of acupuncture and the course of rehabilitation department to do a consolidation therapy.