拮抗针法治疗脑梗死下肢痉挛的临床疗效及对肌肉形态的影响  

Clinical efficacy of antagonistic needling therapy on post-stroke lower limb spasticity and its effect on muscle morphology

作　　者：余婷 王建伟 焦新宇 李博镭 张鑫浩宁 祝鹏宇[5] YU Ting;WANG Jianwei;JIAO Xinyu;LI Bolei;ZHANG Xinhaoning;ZHU Pengyu(Graduate School,Heilongjiang University of CM,Harbin 150040,China;Heilongjiang Provincial Hospital;Ultrasound Department,Second Affiliated Hospital of Heilongjiang University of CM,Harbin 150000;Heilongjiang University of CM;Eighth Department of Acupuncture and Moxibustion,Second Affiliated Hospital of Heilongjiang University of CM,Harbin 150000)

机构地区：[1]黑龙江中医药大学研究生院,哈尔滨150040 [2]黑龙江省医院 [3]黑龙江中医药大学附属第二医院彩超室,哈尔滨150000 [4]黑龙江中医药大学 [5]黑龙江中医药大学附属第二医院针灸八科室,哈尔滨150000

出　　处：《中国针灸》2025年第2期139-145,共7页Chinese Acupuncture & Moxibustion

基　　金：国家重点研发计划项目:2018YFE0181700;国家中医药管理局第七批全国老中医药专家学术经验继承工作项目:国中医药办人教函[2021]272号;黑龙江省中医药经典普及化研究专项项目:ZYW2023-007;黑龙江省博士后科研启动资金项目:21092230028;黑龙江省中医药科研项目:ZHY2022-052。

摘　　要：目的:观察拮抗针法对脑梗死患者下肢痉挛及胫骨前肌、腓肠肌肌肉形态的影响。方法:将100例脑梗死伴下肢痉挛患者随机分为拮抗针法组(50例,脱落1例)和常规针刺组(50例,脱落1例)。两组患者均予基础治疗和康复功能训练。常规针刺组采用头针(患侧顶颞前斜线、顶旁1线)联合体针(患侧肩髃、合谷、足三里、太冲等)治疗,曲池与合谷、足三里与丰隆、阳陵泉与太冲分别为一组连接电针仪,予疏波,频率2 Hz;拮抗针法组头针及上肢取穴同常规针刺组,下肢予拮抗针法治疗,穴取患侧阳陵泉、丘墟、解溪、悬钟,曲池与合谷、阳陵泉与丘墟、解溪与悬钟分别为一组连接电针仪,予疏波,频率2Hz。两组均每日1次,连续治疗6d为一疗程,共治疗4个疗程。分别于治疗前后观察两组患者下肢改良Ashworth痉挛评定量表分级、Holden步行功能分级(FAC)、下肢Fugl-Meyer运动功能评定(FMA)评分、综合痉挛量表评定(CSS)评分和肌骨超声测定指标(双侧胫骨前肌肌肉厚度、肌纤维长度和双侧腓肠肌肌肉厚度、肌纤维长度、羽状角),并比较两组临床疗效。结果:治疗后两组患者改良Ashworth痉挛评定量表分级、CSS评分均较治疗前降低(P<0.01),且拮抗针法组低于常规针刺组(P<0.05,P<0.01);两组患者FAC分级、FMA评分均较治疗前升高(P<0.01,P<0.05),且拮抗针法组高于常规针刺组(P<0.05)。治疗后,两组患者患侧胫骨前肌肌肉厚度、肌纤维长度与腓肠肌肌肉厚度、肌纤维长度、羽状角均大于治疗前(P<0.01),且拮抗针法组大于常规针刺组(P<0.01,P<0.05);两组患者健侧胫骨前肌肌肉厚度、肌纤维长度与腓肠肌肌肉厚度、肌纤维长度、羽状角均大于治疗前(P<0.01,P<0.05),且拮抗针法组小于常规针刺组(P<0.01,P<0.05)。拮抗针法组总有效率为91.8%(45/49),高于常规针刺组的81.6%(40/49,P<0.05)。结论:拮抗针法可有效改善脑梗死患者下肢痉�Objective To observe the effects of antagonistic needling therapy on lower limb spasticity and the muscle morphology of the tibialis anterior and gastrocnemius in patients with stroke.Methods A total of 100 patients with post-stroke lower limb spasticity were randomly divided into an antagonistic needling group(50 cases,1 case dropped out)and a routine acupuncture group(50 cases,1 case dropped out).Both groups received basic treatment and rehabilitation training.The routine acupuncture group was treated with scalp acupuncture at anterior oblique line of vertex-temporal and vertex lateral line 1,combined with body acupuncture at Jianyu(LI15),Hegu(LI4),Zusanli(ST36),Taichong(LR3),etc.on the affected side,with Quchi(LI11)and Hegu(LI4),Zusanli(ST36)and Fenglong(ST40),Yanglingquan(GB34)and Taichong(LR3)connected to an electroacupuncture device,using disperse wave at 2 Hz of frequency.The antagonistic needling group used the same scalp and upper limb acupoints as the routine acupuncture group,with additional antagonistic needling on the lower limb at Yanglingquan(GB34),Qiuxu(GB40),Jiexi(ST41),and Xuanzhong(GB39)on the affected side,with Quchi(LI11)and Hegu(LI4),Yanglingquan(GB34)and Qiuxu(GB40),Jiexi(ST41),and Xuanzhong(GB39)connected to an electroacupuncture device,using disperse wave at 2 Hz of frequency.Both groups received treatment once daily for 6 consecutive days per course,with a total of 4 courses.The modified Ashworth scale(MAS),Holden functional ambulation classification(FAC),lower limb Fugl-Meyer assessment(FMA),composite spasticity scale(CSS),and musculoskeletal ultrasound parameters(thickness and fiber length of the tibialis anterior and gastrocnemius,and pennation angle of the gastrocnemius on both sides)were evaluated before and after treatment.Clinical efficacy was compared between the two groups.Results Compared before treatment,the MAS grades and CSS scores were decreased in both groups after treatment(P<0.01),with greater reductions in the antagonistic needling group(P<0.05,P<0.01).FAC grades and FM

关 键 词：脑梗死 下肢痉挛 针刺 拮抗针法 下肢运动功能 肌骨超声 随机对照试验 

分 类 号：R246.6[医药卫生—针灸推拿学]