毫火针针刺经筋结点联合中频脉冲电疗法治疗卒中后上肢痉挛伴肩关节半脱位疗效观察  

Clinical observation of filiform fire-needling at the tendon joint point combined with medium frequency pulse electrotherapy on upper limb spasm and subluxation of shoulder joint after stroke

作　　者：宋泽新 SONG Zexin(Department of Rehabilitation,Hospital Peace Campus Clinic of Jilin University School,Changchun,Jilin 130062)

机构地区：[1]吉林大学校医院和平校区门诊部康复科,吉林长春130062

出　　处：《河北中医》2018年第8期1228-1233,1241,共7页Hebei Journal of Traditional Chinese Medicine

摘　　要：目的观察毫火针针刺经筋结点联合中频脉冲电疗法治疗卒中后上肢痉挛伴肩关节半脱位的临床疗效。方法将105例卒中后上肢痉挛伴肩关节半脱位患者按照随机数字表法分为3组。毫火针针刺经筋结点联合中频脉冲电疗法组(以下简称联合组)35例在西医常规治疗基础上加用毫火针针刺经筋结点联合中频脉冲电疗法治疗;中频脉冲电疗法组(以下简称电疗组)35例在西医常规治疗基础上加用中频脉冲电疗法治疗;西医组35例单纯予西医常规治疗。3组均治疗4周后,比较3组治疗前后患侧肩关节关节活动度改善情况,包括前屈、后伸、内收、外展、内旋及外旋;比较3组治疗前后患侧肩部疼痛视觉模拟评分法(VAS)评分、肩峰-肱骨头间距(AHI)、上肢活动功能Fugl-Meyer量表(FMA)评分及日常活动能力Barthel指数(BI)评分改善情况;比较3组治疗前后患侧上肢改良Ashworth痉挛评定量表(MAS)分级情况;比较3组治疗前后患侧上肢神经电生理指标变化情况,包括腋神经及正中神经H反射潜伏期及H反射中最大H波波幅与最大M波波幅比值(Hmax/Mmax)。结果与本组治疗前比较,3组治疗后肩关节前屈、后伸、内收、外展、内旋及外旋活动度均明显增加(P<0.05),其中联合组与电疗组治疗后肩关节活动度各指标改善均优于西医组(P<0.05),联合组治疗后肩关节前屈、后伸、内收活动度均明显大于电疗组(P<0.05);与本组治疗前比较,3组治疗后疼痛VAS评分及AHI值均明显降低(P<0.05),FMA评分及BI评分均明显增加(P<0.05),其中联合组治疗后对各指标改善均优于西医组及电疗组(P<0.05),电疗组治疗后对各指标改善均优于西医组(P<0.05);与本组治疗前比较,3组治疗后MAS分级情况均有明显降低趋势(P<0.05),其中联合组治疗后MAS评级降低趋势明显大于西医组与电疗组(P<0.05),电疗组治疗后MAS评级降低趋势明显大于西医组(P<0.05);与本组治疗Objective To observe the clinical effects of filiform fire-needling at the tendon joint point combined with medium frequency pulse electrotherapy on upper limb spasm and subluxation of shoulder joint after stroke.Methods 105 patients with upper limb spasm and subluxation of shoulder joint after stroke were divided into three groups according to the random number table.35 cases in filiform fire-needling at the tendon joint point combined with medium frequency pulse electrotherapy group（hereinafter referred to as the joint group）were treated by filiform fire-needling at the tendon joint point combined with medium frequency pulse electrotherapy on the basis of western medicine.35 cases in medium frequency pulse electrotherapy（hereinafter referred to as the electrotherapy group）were treated by medium frequency pulse electrotherapy on the basis of western medicine.35 cases in western medicine group were treated by western medicine.After 4 weeks of treatment in all three groups,the improvement of joint mobility of the shoulder joints before and after treatment in three groups,including flexion,extension,adduction,abduction,internal rotation and external rotation were compared.The visual analog scale（VAS）score,the shoulderhumidal head spacing（AHI）,the upper limb activity function Fugl-Meyer scale（FMA）score,and the daily activity ability Barthel index（BI）in three groups were compared before and after treatment.The Ashworth spasm rating scale（MAS）of the upper limbs in three groups were compared before and after treatment.The changes of electrophysiological indexes of upper limb nerve were compared before and after treatment in three groups,including H-reflex latency of axillary nerve and median nerve and the ratio of maximum H-wave amplitude to maximum M-wave amplitude（Hmax/Mmax）.Results Compared with the group before treatment,the shoulder flexion,extension,adduction,abduction,internal rotation and external rotation activity of the three groups were significantly increased after treatment�

关 键 词：卒中 中风后遗症 肌痉挛状态 肩关节 火针疗法 电刺激疗法 

分 类 号：R245.316[医药卫生—针灸推拿学] R255.2[医药卫生—中医临床基础]