关刺结合体外冲击波治疗卒中后下肢痉挛的疗效观察  

Efficacy Observation on Articular Needling Combined with Extracorporeal Shock Wave Therapy on Lower Limb Spasms after Stroke

作　　者：饶美林 朱宗俊 纵亚[3] 陈瑞全 张靓男 刘华胜 王雅 肖洪波[1,2] Rao Meilin;Zhu Zongjun;Zong Yu;Chen Ruiquan;Zhang Liangnan;Liu Huasheng;Wang Ya;Xiao Hongbo(The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine,Anhui,Hefei 230031,China)

机构地区：[1]安徽中医药大学第一附属医院,安徽合肥230031 [2]安徽中医药大学,安徽合肥230031 [3]上海交通大学医学院附属瑞金医院,上海200025

出　　处：《中国中医急症》2024年第4期647-651,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：安徽省2020年度中央财政中医药事业传承与发展专项资金项目(皖卫中医药发[2020]5号);第二批省级中医优势(特色)专科(皖中医药服务秘[2022]34号)。

摘　　要：目的观察关刺结合体外冲击波治疗卒中后下肢痉挛的疗效并探寻其作用机制。方法70例患者随机分为观察组(35例,脱落2例)与对照组(35例,脱落1例)。两组均予以常规内科治疗及常规康复训练,对照组进行体外冲击波治疗,观察组在对照组基础上联合关刺治疗,治疗前和治疗3周后分别评定两组患者改良Ashworth量表(MAS)、Fugl-Meyer运动功能评分下肢部分(FMA-LE)、改良Barthel指数(MBI),并运用超声评估偏瘫侧腓肠肌的肌肉厚度(MT)、肌纤维长度(FL)、羽状角(PA),最后进行临床疗效评定。结果两组治疗后MAS评分与治疗前比较均下降,FMA-LE评分、MBI评分则均提高,且观察组均优于对照组(P<0.05)。两组治疗后患者腓肠肌超声各指标MT、FL、PA均改善,且观察组均优于对照组(均P<0.05)。观察组总有效率为81.82%,高于对照组的58.82%(P<0.05)。两组均未出现严重不良反应。结论关刺结合体外冲击波治疗能够改善卒中后下肢痉挛状态,可提高下肢运动功能与日常生活活动能力,有利于卒中后下肢痉挛的恢复。Objective:To observe the therapeutic effect of articular needling combined with extracorporeal shock wave therapy(ESWT)on lower limb spasms after stroke.Methods:Totally 70 cases were randomly divided into a control group(35 cases,1 case dropped off)and an observation group(35 cases,2 cases dropped off).The two groups were given routine medical therapy and conventional rehabilitation training.The control group was treated with ESWT,and the observation group was combined with articular needling on the basis of the control group.The Modified Ashworth Scale(MAS),Fugl-Meyer assessment lower extremity(FMA-LE),Modified Bathel Index(MBI)were used to evaluate patients before treatment and after 3 weeks of treatment.Ultrasound was used to evaluate the muscle thickness(MT),fascicle length(FL),and pinnation angle(PA)of the gastrocnemius muscle on the hemiplegic side.Finally,the clinical efficacy was evaluated.Results:After treatment,the MAS score,FMA-LE score,MBI score,and gastrocnemius ultrasound indicators(MT,FL,PA)of both groups were significantly improved compared with before treatment(P<0.05),and the observation group was better than those of the control group(P<0.05).The total effective rate of the observation group was 81.82%,which was higher than 58.82%of the control group(P<0.05).Conclusion:Articular needling combined with ESWT can improve the lower limb spasms after stroke,improve the lower limb motor function and daily living ability,and facilitate the recovery of lower limb spasms after stroke.

关 键 词：脑卒中 下肢痉挛 关刺 体外冲击波 

分 类 号：R473[医药卫生—护理学]