超声弹性成像评价股四头肌神经入肌点针刺法治疗脑梗死肌痉挛的临床疗效  

Application of ultrasound elastography in assessing the efficacy of acupuncture nerve entering points on quadriceps femoris for spastic hemiplegia patients

作　　者：樊留博 刘宝华[2] 韩文胜 FAN Liubo;LIU Baohua;HAN Wensheng(Department of Rehabilitation of Medical,Taizhou Hospital Affiliated to Wenzhou Medical University,Zhejiang 317000,China)

机构地区：[1]温州医科大学附属台州医院康复医学科,浙江省台州市317000 [2]温州医科大学附属第二医院康复医学科

出　　处：《临床超声医学杂志》2019年第4期263-266,共4页Journal of Clinical Ultrasound in Medicine

基　　金：浙江省自然科学基金项目(LSY19H170001);浙江省医药卫生科技计划项目(2014KYA224;2017KY707);浙江省台州市科技计划项目(14SF03);温州医科大学高等教育教学改革项目(YBJG201621)

摘　　要：目的应用超声弹性成像评价股四头肌神经入肌点针刺法治疗脑梗死后痉挛性偏瘫患者的临床疗效。方法选取脑梗死偏瘫后下肢痉挛患者44例,随机分为入肌点针刺组和传统针刺组各22例,两组均给予相同的基础治疗,传统针刺组采用传统的循经取穴针刺治疗,入肌点针刺组采用股四头肌神经入肌点针刺疗法。应用超声弹性成像技术检测针刺前后下肢股外侧肌、股内侧肌、股直肌及股二头肌,记录并比较组织弹性图和杨氏模量值;两组患者分别于治疗前和治疗4个疗程后进行改良Ashworth分级、临床痉挛指数(CSI)评分、Berg平衡功能(BBS)评分。结果治疗4周后入肌点针刺组患者患侧股外侧肌、股内侧肌、股直肌及股二头肌杨氏模量值均较治疗前减小,差异均有统计学意义(均P<0.05);入肌点针刺组患侧下肢较传统针刺组相应侧下肢下降更显著(均P<0.01)。两组治疗后下肢改良Ashworth分级及CSI评分均较治疗前明显下降(均P<0.01);入肌点针刺组较传统针刺组下降更显著,两组比较差异有统计学意义(P<0.05)。两组治疗后BBS评分均较治疗前明显提高(均P<0.01),入肌点针刺组与传统针刺组比较差异有统计学意义(P<0.05)。结论股四头肌神经入肌点针刺法治疗可明显缓解脑梗死偏瘫侧下肢痉挛,疗效优于传统针刺方法。超声弹性成像可以准确评估其疗效。Objective To observe the effects of acupuncture nerve entering points on quadriceps femoris in lower limb spasticity after stroke by ultrasound elastography. Methods Forty-four patients with spastic hemiplegia were divided into two groups,there were 22 patients in observation group which were treated by acupuncture nerve entering points on quadriceps femoris,and 22 patients in control group which were treated only by the traditional acupuncture. Modified ashworth scale(MAS), clinic spasticity index(CSI),Berg balance scale(BBS)and analysis of the tissue elastic graph and young’s modulus value were used as outcome measure pre - treatment and post - treatment after 4 weeks by two appointed raters. Results After treatment for 4 week. BBS scores in both groups were significantly increased,and the lower extremity MAS scores and CSI in both groups were decreased significantly as compared with those before treatment(all P<0.01),and the decrease in observation group was more significant than that in control group(P<0.05). Longitudinal Young’s modulus values of the vastus lateralis,vastus medialis,rectus femoris and biceps femoris of observation group were lower than before treatment during knee maximum isometric voluntary contraction(all P<0.05),and the decrease in observation group was more significant than that in control group (P<0.01). Conclusion The method of acupuncture nerve entering points on quadriceps femoris can effectively improve stroke patients lower limb function and promote the recovery of patients.The recuperative effect of opposing needling is superior to either only traditional acupuncture treatment.Ultrasound elastography can evaluate the efficacy accurately.

关 键 词：超声弹性成像 针刺神经入肌点 杨氏模量值 痉挛 脑梗死 

分 类 号：R445.1[医药卫生—影像医学与核医学] R743[医药卫生—诊断学]