Huang Xin-Yun, Xia Qiu-Fang, Zhu Hui-Wen, Jiang Shu-Yun, Yu Yan, Zhu Run-Jia, Chen Xiao-Tong, Li Jing
Department of Acupuncture and Moxibustion, Yueyang Integrated Chinese and Western Medicine Hospital Affiliated to Shanghai University of TCM, Shanghai 200437, China.
Department of Chinese Medicine Rehabilitation, Shanghai First Rehabilitation Hospital.
Zhongguo Zhen Jiu. 2020 May 12;40(5):473-8. doi: 10.13703/j.0255-2930.20190505-0006.
To compare the clinical therapeutic effect on post-stroke spastic paralysis of the upper extremity between the combination of kinematic-acupuncture therapy and rehabilitation training and the combined treatment of the conventional acupuncture with rehabilitation training.
A total of 60 patients of post-stroke spastic paralysis of the upper extremity at the non-acute stage were randomized into an observation group (30 cases) and a control group (30 cases, 1 case dropped off). On the base of the routine western medication and rehabilitation treatment, the kinematic-acupuncture therapy was added in the observation group and the conventional acupuncture was used in the control group. Baihui (GV 20), Dazhui (GV 14), Jiaji (EX-B 2) from T to T, Tianzong (SI 11), Jianzhen (SI 9), Jianyu (LI 15) and Quyuan (SI 13) were selected in both groups. The treatment was given once daily and the treatment for 14 days was as one course. The one course of treatment was required in this research. Separately, before treatment and in 7 and 14 days of treatment, the score of simplified Fugl-Meyer scale of the upper extremity (FMA-UE), the grade of the modified Ashworth scale (MAS) and the score of the modified Barthel index scale (MBI) were compared between the two groups.
Compared before treatment, in 7 and 14 days of treatment, FMA-UE score was increased obviously in either group (<0.01). In 14 days of treatment, FMA-UE score in the observation group was higher than that in the control group (<0.05). In 7 and 14 days of treatment, MAS grades of shoulder joint, elbow joint, wrist joint and metacarpophalangeal joint were all improved markedly in the two groups (<0.05). Compared with the grades in 7 days of treatment, MAS grades of elbow joint and metacarpophalangeal joint were improved markedly in 14 days of treatment in the two groups (<0.05). Compared with the control group, MAS grades of elbow joint and metacarpophalangeal joint were improved more markedly in the observation group in 14 days of treatment (<0.05). Compared with the score before treatment, MBI score was increased in 7 and 14 days of treatment respectively in the observation group (<0.05, <0.01). In 14 days of treatment, MBI score was increased in the control group (<0.01).
For the patients with post-stroke spastic paralysis of the upper extremity at the non-acute stage, the combined treatment with kinematic-acupuncture therapy and rehabilitation training obviously improves the motor function of the upper extremity and the muscle tone of elbow joint and metacarpophalangeal joint. The therapeutic effect of this combination is better than that of the combined treatment of the conventional acupuncture with rehabilitation training. Additionally, this combined therapy improves the ability of daily life activity.
比较运动针法联合康复训练与传统针刺联合康复训练对脑卒中后上肢痉挛性瘫痪的临床治疗效果。
将60例非急性期脑卒中后上肢痉挛性瘫痪患者随机分为观察组（30例）和对照组（30例，脱落1例）。两组均在西医常规药物及康复治疗基础上，观察组加用运动针法，对照组采用传统针刺。两组均选取百会（GV20）、大椎（GV14）、T1～T12夹脊（EX - B2）、天宗（SI11）、肩贞（SI9）、肩髃（LI15）、曲垣（SI13）。每日治疗1次，14天为1个疗程，本研究要求治疗1个疗程。分别比较两组治疗前及治疗7天、14天时上肢简化Fugl - Meyer量表（FMA - UE）评分、改良Ashworth量表（MAS）分级及改良Barthel指数量表（MBI）评分。
与治疗前比较，两组治疗7天、14天时FMA - UE评分均明显升高（P＜0.01）。治疗14天时，观察组FMA - UE评分高于对照组（P＜0.05）。两组治疗7天、14天时肩关节、肘关节、腕关节及掌指关节的MAS分级均明显改善（P＜0.05）。两组治疗14天时肘关节及掌指关节的MAS分级较治疗7天时明显改善（P＜0.05）。治疗14天时，观察组肘关节及掌指关节的MAS分级较对照组改善更明显（P＜0.05）。与治疗前评分比较，观察组治疗7天、14天时MBI评分分别升高（P＜0.05，P＜0.01）。治疗14天时，对照组MBI评分升高（P＜0.01）。
对于非急性期脑卒中后上肢痉挛性瘫痪患者，运动针法联合康复训练能明显改善上肢运动功能及肘关节、掌指关节肌肉张力，其治疗效果优于传统针刺联合康复训练，且能提高日常生活活动能力。
