Ding Yu-Ju, Liu Zhao-Yong, Xiao Rong, Zhang Bo
Department of Rehabilitation, Eighth People's Hospital of Hefei, Hefei 238000, Anhui Province, China.
Department of Encephalopathy, First Affiliated Hospital of Anhui University of CM, Hefei 230038.
Zhongguo Zhen Jiu. 2023 Aug 12;43(8):899-903. doi: 10.13703/j.0255-2930.20220916-k0003.
To observe the clinical efficacy on hemiplegic shoulder pain (HSP) after stroke treated with electroacupuncture (EA) under different frequencies.
A total of 105 patients with HSP after stroke were randomly divided into a manual acupuncture group (35 cases, 2 cases dropped off), an EA continuous wave group (35 cases, 3 cases dropped off) and an EA disperse-dense wave group (35 cases). The conventional rehabilitation therapy was delivered in the three groups. Additionally, acupuncture was applied to Jianyu (LI 15), Jianzhen (SI 9), Jianliao (TE 14) and Jianqian (Extra) etc. on the affected side in the manual acupuncture group. In the EA continuous wave group and the EA disperse-dense wave group, besides the treatment as the manual acupuncture group, the electric stimulation was attached to two pairs of acupoints, i.e. Jianyu (LI 15) and Jianliao (TE 14), and Quchi (LI 11) and Shousanli (LI 10), with 15 Hz continuous wave, and 2 Hz/ 100 Hz disperse-dense wave, respectively. The treatment was given once daily, 5 times a week, for 4 weeks consecutively. The score of visual analogue scale (VAS) before treatment and after 2 and 4 weeks of treatment, as well as the passive range of motion (PROM) of shoulder forward flexion and PROM of shoulder abduction, muscle strength of the upper limb, the score of modified Barthel index (MBI) and the score of Fugl-Meyer assessment (FMA) before and after treatment were observed in each group.
Compared with before treatment, VAS scores were reduced after 2 and 4 weeks of treatment in each group (<0.05); and VAS scores after 4 weeks of treatment were lower than those after 2 weeks of treatment (<0.05). After 2 and 4 weeks of treatment, VAS score in either the EA continuous wave group or the EA disperse-dense wave group was lower compared with the manual acupuncture group (<0.05). After 4 weeks of treatment, VAS score in the EA disperse-dense wave was lower than that of the EA continuous wave group (<0.05). Compared with before treatment, PROM of the shoulder forward flexion and abduction on the affected side after treatment was enlarged (<0.05), the muscle strength of the upper limb was increased (<0.05), and the scores of MBI and FMA were increased (<0.05) in the patients of each group. After treatment, in the EA continuous wave group and the EA disperse-dense wave group, PROM of the shoulder forward flexion on the affected side was higher (<0.05), the muscle strength of the upper limb was stronger (<0.05) when compared with the manual acupuncture group; and the scores of MBI and FMA in the EA disperse-dense wave group were higher than those of the manual acupuncture group (<0.05).
Electroacupuncture is superior to manual acupuncture in the analgesic effect and comprehensive rehabilitation effect in the patients with HSP after stroke. The therapeutic effect obtained by electroacupuncture with 2 Hz/100 Hz disperse-dense wave is better than that with 15 Hz continuous wave.
观察不同频率电针治疗脑卒中后偏瘫肩痛(HSP)的临床疗效。
将105例脑卒中后HSP患者随机分为手针组(35例,脱落2例)、电针连续波组(35例,脱落3例)和电针疏密波组(35例)。三组均给予常规康复治疗。此外,手针组在患侧针刺肩髃(LI 15)、肩贞(SI 9)、肩髎(TE 14)及肩前(奇穴)等穴位。电针连续波组和电针疏密波组除与手针组相同治疗外,分别在肩髃(LI 15)和肩髎(TE 14)、曲池(LI 11)和手三里(LI 10)两对穴位上施加电刺激,频率分别为15Hz连续波和2Hz/100Hz疏密波。治疗每日1次,每周5次,连续治疗4周。观察每组治疗前及治疗2周、4周后的视觉模拟评分(VAS)、患侧肩关节前屈被动活动度(PROM)、肩关节外展PROM、上肢肌力、改良Barthel指数(MBI)评分及Fugl-Meyer评估(FMA)评分。
与治疗前比较,各组治疗2周、4周后VAS评分均降低(P<0.05);治疗4周后的VAS评分低于治疗2周后(P<0.05)。治疗2周、4周后,电针连续波组和电针疏密波组的VAS评分均低于手针组(P<0.05)。治疗4周后,电针疏密波组的VAS评分低于电针连续波组(P<0.05)。与治疗前比较,各组患者治疗后患侧肩关节前屈和外展的PROM增大(P<0.05),上肢肌力增强(P<0.05),MBI和FMA评分升高(P<0.05)。治疗后,电针连续波组和电针疏密波组患侧肩关节前屈PROM高于手针组(P<0.05),上肢肌力强于手针组(P<0.05);电针疏密波组的MBI和FMA评分高于手针组(P<0.05)。
电针治疗脑卒中后HSP患者的镇痛效果和综合康复效果优于手针。2Hz/100Hz疏密波电针的治疗效果优于15Hz连续波电针。