Yu Ting, Wang Jianwei, Jiao Xinyu, Li Bolei, Zhang Xinhaoning, Zhu Pengyu
Graduate School, Heilongjiang University of CM, Harbin 150040, China.
Heilongjiang Provincial Hospital.
Zhongguo Zhen Jiu. 2025 Feb 12;45(2):139-45. doi: 10.13703/j.0255-2930.20240411-k0001.
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.
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.
Compared before treatment, the MAS grades and CSS scores were decreased in both groups after treatment (<0.01), with greater reductions in the antagonistic needling group (<0.05, <0.01). FAC grades and FMA scores were increased in both groups after treatment (<0.01, <0.05), with greater improvements in the antagonistic needling group (<0.05). The muscle thickness, fiber length of the tibialis anterior, the muscle thickness, fiber length and pennation angle of the gastrocnemius on the affected side were improved in both groups after treatment (<0.01), with greater improvements in the antagonistic needling group (<0.01, <0.05). On the unaffected side, these parameters were also increased after treatment in both groups (<0.01, <0.05), but the antagonistic needling group showed smaller increases than the routine acupuncture group (<0.01, <0.05). The total effective rate in the antagonistic needling group was 91.8% (45/49), higher than 81.6% (40/49) in the routine acupuncture group (<0.05).
Antagonistic needling could effectively reduce spasticity, improve motor function, and enhance muscle structure in patients with post-stroke lower limb spasticity.
观察拮抗针法对脑卒中患者下肢痉挛及胫前肌和腓肠肌肌肉形态的影响。
将100例脑卒中后下肢痉挛患者随机分为拮抗针刺组（50例，脱落1例）和常规针刺组（50例，脱落1例）。两组均接受基础治疗和康复训练。常规针刺组采用顶颞前斜线、顶旁1线头针，配合患侧肩髃（LI15）、合谷（LI4）、足三里（ST36）、太冲（LR3）等体针，将曲池（LI11）与合谷（LI4）、足三里（ST36）与丰隆（ST40）、阳陵泉（GB34）与太冲（LR3）连接电针仪，选用频率2Hz的疏密波。拮抗针刺组头皮及上肢穴位与常规针刺组相同，患侧下肢增加阳陵泉（GB34）、丘墟（GB40）、解溪（ST41）、悬钟（GB39）拮抗针刺，将曲池（LI11）与合谷（LI4）、阳陵泉（GB34）与丘墟（GB40）、解溪（ST41）、悬钟（GB39）连接电针仪，选用频率2Hz的疏密波。两组均每日治疗1次，每个疗程连续治疗6天，共治疗4个疗程。治疗前后采用改良Ashworth量表（MAS）、Holden步行功能分级（FAC）、下肢Fugl-Meyer评估（FMA）、综合痉挛量表（CSS）以及肌肉骨骼超声参数（双侧胫前肌和腓肠肌厚度、纤维长度，腓肠肌羽状角）进行评定。比较两组临床疗效。
与治疗前比较，两组治疗后MAS分级及CSS评分均降低（<0.01），拮抗针刺组降低更明显（<0.05，<0.01）。两组治疗后FAC分级及FMA评分均升高（<0.01，<0.05），拮抗针刺组改善更显著（<0.05）。两组治疗后患侧胫前肌厚度、纤维长度，腓肠肌厚度、纤维长度及羽状角均改善（<0.01），拮抗针刺组改善更明显（<0.01，<0.05）。两组治疗后健侧上述参数也升高（<0.01，<0.05），但拮抗针刺组升高幅度小于常规针刺组（<0.01，<0.05）。拮抗针刺组总有效率为91.8%（45/49），高于常规针刺组的81.6%（40/49）（<0.05）。
拮抗针法能有效降低脑卒中后下肢痉挛患者的痉挛程度，改善运动功能，增强肌肉结构。
