摘要
目的观察针刺拮抗肌结合辨证取穴治疗缺血性卒中偏瘫患者腕踝关节活动障碍的临床康复效果。方法将168例缺血性卒中偏瘫患者按照随机数字表法分为2组。2组均接受西医常规内科药物治疗,对照组84例加辨证取穴针刺治疗;治疗组84例在对照组治疗基础上予针刺拮抗肌治疗。针刺治疗隔日1次,疗程2个月。观察2组临床疗效,比较2组治疗前后腕、踝关节改良Ashworth分级、Barthel指数评分及患侧肢体肌电图检查的变化。结果治疗组疗效优于对照组(P<0.05)。2组治疗后腕关节、踝关节改良Ashworth分级较治疗前明显改善(P<0.05),2组治疗后改良Ashworth分级比较差异无统计学意义(P>0.05)。治疗后2组Barthel指数评分均升高(P<0.05),且治疗组Barthel指数评分高于对照组(P<0.05)。治疗后2组桡侧腕伸肌及胫骨前肌波相较本组治疗前比较均改善(P<0.05);治疗组治疗后桡侧腕伸肌波相改善优于对照组(P<0.05)。结论针刺拮抗肌结合辨证取穴对缺血性卒中偏瘫患者腕踝关节活动障碍有改善作用,可以改善关节痉挛,提高日常生活能力,作用机制可能与恢复拮抗肌的运动单位功能有关。
Objective To observe the effect of acupuncture on antagonistic muscle combined with syndrome differentiation and acupoint selection on rehabilitation of wrist ankle joint in hemiplegia patients with ischemic stroke. Methods 168 hemiplegic patients with ischemic stroke were divided into two groups according to the random number table method. Both groups were treated by conventional western medicine. 84 cases in control group were treated by acupuncture according to syndrome differentiation. 84 cases in treatment group were treated by acupuncture on antagonistic muscle on the basis of the control group. Acupuncture treatment was once every other day for 2 months. The clinical effects of the two groups were observed. The changes of Ashworth grade, Barthel index score and electromyography of affected side of wrist and ankle in two groups were compared before and after treatment. Results The therapeutic effect of the treatment group was better than that of the control group(P<0.05). The Ashworth grade of wrist joint and ankle joint in the two groups was significantly improved after treatment(P<0.05). There was no significant difference in Ashworth grade between the two groups after treatment(P>0.05). After treatment, the scores of Barthel index were increased in both groups(P<0.05), and the treatment group was higher than the control group(P<0.05). After treatment, the wave phase of the extensor carpi radialis and tibialis anterior muscle in the two groups were improved(P<0.05). The wave phase of the extensor carpi radialis in the treatment group was better than that in the control group(P<0.05). Conclusion Acupuncture on antagonistic muscle combined with syndrome differentiation can improve the dyskinesia of wrist ankle joint in hemiplegia patients with ischemic stroke. It can improve joint spasm and improve the ability of daily life. The mechanism of action may be related to the recovery of motor unit function of antagonistic muscle.
作者
李丽
吴耀持
吕瑛
LI Li;WU Yaochi;LV Ying(Department of Traditional Chinese Medicine,Shanghai Tongren Hospital,Shanghai 200336)
出处
《河北中医》
2019年第12期1883-1887,1892,共6页
Hebei Journal of Traditional Chinese Medicine
基金
上海市卫生和计划生育委员会中医药科研基金课题(编号:2014LQ023A)
上海市虹口区“国医强优”三年行动计划(2018—2020年)名中医工作室(站)建设项目(编号:HGY-MZY-2018-07)
上海市中医药事业发展三年行动计划“杏林新星”人才培养项目(编号:ZY3-RCPY-2-2082)
关键词
卒中
偏瘫
腕关节
踝关节
康复
针刺疗法
Stroke
Hemiplegia
Wrist joint
Ankle joint
Rehabilitation
Acupuncture therapy
