不同穴位针刺结合康复训练对偏瘫患者肌痉挛的影响

Effects of acupuncture on different acupoints in combination with rehabilitation on hemiplegic muscle spasticity in hemiplegia patients

目的:观察不同穴位针刺结合康复训练治疗偏瘫患者肌痉挛的临床疗效。方法:选取90例中风肌痉挛患者,随机分成对应与中轴针刺组、常规针刺组和康复治疗组,各30例。对应与中轴针刺组采用针刺结合康复训练,取穴以督脉穴位为主配合手少阳经和足太阳经穴;常规针刺组采用传统针刺结合康复训练的方法,取穴以手足阳明经为主,配合少阳经穴;康复治疗组单纯采用康复训练方法。治疗前、治疗2周后、治疗4周后分别对患者进行改良Ashworth分级评定及CSS评分评定。结果:对应与中轴针刺组治疗后肘、腕关节屈肌改良Ashworth分级较治疗前明显降低(P<0.01);康复治疗组治疗后肘关节屈肌改良Ashworth分级较治疗前明显降低(P<0.05);对应与中轴针刺组与康复治疗组治疗4周后肘关节屈肌改良Ashworth分级比较,差异有统计学意义(P<0.05);治疗后对应与中轴针刺组CSS评分较治疗前明显下降(P<0.01),对应与中轴针刺组治疗后较另外两组改善明显(P<0.01)。结论:对应与中轴针刺结合康复训练能改善偏瘫肢体的肌张力,且优于常规针刺结合康复训练及单纯康复训练治疗。

Objective To observe the clinical effect of hemiplegic muscle spasticity treated with acupuncture on different acupoints in combination with rehabilitation. Methods Ninety cases of post-stroke muscle spasticity were randomized into a corresponding and central axis acupuncture group （group A）, a conventional acupuncture group （group B） and a rehabilitation group （group C）, 30 cases in each one. In group A, the acupoints on the Governor Vessel were mainly selected, as well as those on Hand-Shaoyang meridian and Foot-Taiyang meridian. In group B, the conventional needling and rehabilitation training were applied in combination, of which, the acupoints were mainly from Hand and Foot-Yangming meridians, associated with the acupoints of Shaoyang meridian. In group C, only rehabilitation training was applied. The assessments according to modified Ashworth scale and CSS score were performed before treatment, after 2 weeks and 4 weeks treatment respectively. Results The level of modified Ashworth scale of the flexor of elbow and wrist was reduced apparently after treatment in group A as compared with that before treatment （P〈0.01）. The level of modified Ashworth scale of the flexor of elbow was reduced apparently after treatment in group C as compared with that before treatment （P〈0. 05）. There was significant difference on the level change in modified Ashworth scale for the flexor of elbow between group A and group C after 4 weeks treatment （P〈0.05）. CSS score decreased significantly in group A as compared with that before treatment （P〈0.01）, the improvement after treatment in group A was apparent as compared with the other two groups （P〈0. 01）. Conclusion The corresponding and central axis acupuncture can improve muscle tone of hemiplegic limb, which is superior to the effect achieved by the conventional acupuncture in combination with rehabilitation training and the simple rehabilitation training.