Li Ning, Tian Feng-Wei, Wang Cheng-Wei, Yu Peng-Ming, Zhou Xi, Wen Qian, Qiao Xiu-Lan, Huang Lu
Huaxi Hospital of Sichuan University, Integrated TCM and Western Medicine Department, Chengdu 610041, China.
Zhongguo Zhen Jiu. 2012 Feb;32(2):101-5.
To evaluate clinical therapeutic effect of post-stroke shoulder pain treated by acupuncture combined with Tuina.
Three hundred cases of post-stroke shoulder pain were randomly divided into an acupuncture and Tuina group and a rehabilitation group by double-center randomized controlled clinical trial method. In acupuncture and Tuina group, normalized electroacupuncture and Tuina therapy were applied, that was electroacupuncture at main points, such as Chize (LU 5), Quze (PC 3), Shaohai (HT 3), Jianyu (LI 15), Jianliao (TE 14) and Jianjing (GB 21),etc., combined with traditional Tuina manipulations; in rehabilitation group, the rehabilitation methods such as the electrostimulation through nervus cutaneus and the squeezing and stabilizing manipulations of Proprioceptive Neuromuscular Facilitation (PNF), etc. were applied. The treatment courses of both groups were 6 weeks. The main therapeutic effect indices were the Assessment Face Scale (AFS) for pain when shoulder was in passive motion and the Fugl-Meyer Motor Assessment for upper limbs active function; the secondary indices were the moditied Rankin Scale (mRS) and the clinical incidences of shoulder-hand syndrome of hemiplegia and shoulder joint subluxation of hemiplegia.
After 6 weeks treatment and 12 weeks follow-up, AFS score, Fugl-Meyer motor assessment of upper limbs active function and mRS evaluation in acupuncture and Tuina group were more obviously improved than those in rehabilitation group (P < 0.05, P < 0.01). Although the clinical incidences of shoulder-hand syndrome of hemiplegia and shoulder joint subluxation of hemiplegia in acupuncture and Tuina group was equal to those in rehabilitation group [3.55% (5/141) vs 8.45% (12/142), 1.42% (2/141) vs 5.63% (8/142), both P > 0.05], the data indicated that there was a superiority tendency in acupuncture and Tuina group.
The combined therapy of electroacupuncture and Tuina is a normative manipulation, and the therapeutic effect is satisfying for post-stroke shoulder pain, superior to that of comprehensive rehabilitation treatment.
评价针刺结合推拿治疗中风后肩痛的临床疗效。
采用双中心随机对照临床试验方法，将300例中风后肩痛患者随机分为针刺推拿组和康复组。针刺推拿组采用规范的电针及推拿疗法，即取尺泽（LU 5）、曲泽（PC 3）、少海（HT 3）、肩髃（LI 15）、肩髎（TE 14）、肩井（GB 21）等主穴进行电针治疗，并结合传统推拿手法；康复组采用经皮神经电刺激、本体感觉神经肌肉促进法（PNF）的挤压和稳定手法等康复方法。两组疗程均为6周。主要疗效指标为肩部被动活动时疼痛的面部评估量表（AFS）及上肢主动功能的Fugl-Meyer运动评估；次要指标为改良Rankin量表（mRS）及偏瘫肩手综合征、偏瘫肩关节半脱位的临床发生率。
治疗6周及随访12周后，针刺推拿组的AFS评分、上肢主动功能的Fugl-Meyer运动评估及mRS评分改善程度均明显优于康复组（P<0.05，P<0.01）。针刺推拿组偏瘫肩手综合征及偏瘫肩关节半脱位的临床发生率虽与康复组相当[3.55%（5/141）比8.45%（12/142），1.42%（2/141）比5.63%（8/142），均P>0.05]，但数据显示针刺推拿组有优势倾向。
电针与推拿联合疗法操作规范，治疗中风后肩痛疗效满意，优于综合康复治疗。
