益气通络止痉汤结合干针疗法改善脑卒中踝趾屈肌痉挛膝过伸步态功能:随机对照研究  

Yiqi Tongluo Zhijing Decoction(益气通络止痉汤)Combined with Dry-Needling Therapy Improves Gait Function of Stroke Patients with Ankle and Toe Flexor Spasm and Knee Hyperextension:A Randomized Controlled Study

作　　者：朱艳艳[1] 张中凯 邵蒙蒙[1] 李贤美 孙妙璇 王金金[1] 马琴琴 林玲[1] 李海燕[1] ZHU Yanyan;ZHANG Zhongkai;SHAO Mengmeng;LI Xianmei;SUN Miaoxuan;WANG Jinjin;MA Qinqin;LIN Ling;LI Haiyan(Department of Rehabilitation Medicine,The First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,Zhejiang,China)

机构地区：[1]温州医科大学附属第一医院,浙江温州325000

出　　处：《中华中医药学刊》2023年第6期37-42,共6页Chinese Archives of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81501954);温州市科研项目(Y20190043)。

摘　　要：目的观察益气通络止痉汤结合干针疗法治疗对脑卒中踝趾屈肌痉挛膝过伸病人步态功能的治疗疗效。方法选取2019年7月—2021年4月住院病人60例,将60例病人按信封法随机分为试验组和对照组各30例。对照组予常规康复治疗,试验组在对照组基础上予益气通络止痉汤结合干针疗法治疗。3次/周,共观察2周。采用单盲法分别评估各组治疗前后膝过伸疗效,10 m步行膝过伸次数,踝关节CSI(clinic spasticity index,CSI)评分,被动踝关节背屈角度,超声评估腓肠肌厚度,羽状角及肌纤维长度,下肢Fugl-Meyer(FMA),Holden分级,Barthel指数(BI)。结果①膝过伸的治疗有效率方面试验组(90.00%,27/30)较对照组更高(63.33%,19/30),差异有统计学意义(P<0.05)。两组病人治疗后10 m步行膝过伸次数和治疗前对比改善明显,且试验组较对照组更优,差异有统计学意义(P<0.05)。②试验组病人治疗后踝关节CSI评定,踝关节被动背屈角度,和治疗前对比改善明显,差异有统计学意义(P<0.05),且和对照组对比,治疗前后的差值更为明显,差异有统计学意义(P<0.05)。试验组病人治疗后的腓肠肌内侧头肌纤维长度较对照组增加显著,羽状角较对照组相比下降显著,差异有统计学意义(P<0.05)。③治疗后试验组病人下肢FMA评分,Holden分级,Barthel指数(BI)与治疗前比较显著改善,差异有统计学意义(P<0.05)。结论益气通络止痉汤结合干针疗法可改善脑卒中膝过伸病人踝趾屈张力,增加腓肠肌内侧头肌纤维长度,改善膝过伸步态,促进下肢功能恢复,增加步行能力,提高生活质量。Objective To observe the therapeutic effect of Yiqi Tongluo Zhijing Decoction(益气通络止痉汤)combined with dry-needling therapy on gait function of stroke patients with ankle and toe flexor spasm and knee hyperextension.Methods A to⁃tal of 60 hospitalized patients from July 2019 to April 2021 were selected and randomly divided into two groups,and each group included 30 cases.The control group was given routine rehabilitation therapy and the experimental group was given Yiqi Tongluo Zhijing Decoction combined with dry-needling therapy on the basis of the control group,3 times/week,for a total of 2 weeks.Before and after 2 weeks of treatments,the single-blind method was used to evaluate the effect of knee hyperextension,the num⁃ber of knee hyperextension in 10 meters walk,the clinic spasticity index(CSI)score of ankle joint,the angle of passive ankle dorsiflexion,ultrasound evaluation of gastrocnemius thickness,pinnate angle,muscle fiber length,the lower limb Fugl-Meyer(FMA),Holden classification and Barthel index(BI)were evaluated respectively in each group.Results①The effective rate of knee hyperextension treatment in the experimental group was 90%(27/30),which was obvious better than that of the control group(63.33%,19/30).The difference was statistically obvious(P<0.05).After treatment,the number of knee hyperexten⁃sion at 10 meters walk between two groups was obvious improved compared with that before treatment,and that of the experimental group was better than that of the control group.The difference was statistically obvious(P<0.05).After treatment,the ankle joint CSI assessment and the ankle joint passive dorsiflexion angle of the experimental group were obvious improved compared with those before treatment and the difference was statistically obvious(P<0.05).The difference before and after treatment of the experimental group was statistically obvious compared with that of the control group(P<0.05).After treatment,compared with that the of control group,the fiber length of the medial head of

关 键 词：益气通络止痉汤 脑卒中 肌痉挛 膝过伸 干针疗法 

分 类 号：R245.31[医药卫生—针灸推拿学] R277.743.3[医药卫生—中医临床基础]