针刺结合康复训练治疗脑卒中后足下垂疗效观察

Acupuncture combined with rehabilitation training for foot drop after stroke

目的:比较针刺结合康复训练与单纯康复训练治疗脑卒中后足下垂患者的临床疗效差异。方法:98例脑卒中后足下垂患者随机分为针康组、康复组,各49例,针康组采取针刺联合康复训练的方式,针刺穴取阳陵泉、足三里、光明、悬钟、三阴交等,康复训练进行胫前肌力量训练和小腿三头肌训练等;康复组仅采取与针康组相同的康复训练,两组均每周治疗6次,连续治疗6周。对比两组患者胫前肌肌力、小腿三头肌痉挛程度、足趾屈改善程度及胫骨前肌、腓肠肌外侧头的最大积分肌电值(iEMG),并比较两组患者的康复效果。结果:治疗后,两组患者的胫前肌肌力、胫前肌iEMG、腓肠肌外侧头iEMG值、Fugl-Meyer下肢运动功能评分均较治疗前提高(均P<0.05),小腿三头肌肌张力评分较治疗前降低(P<0.05);治疗后,针康组的胫前肌肌力、胫前肌iEMG值、腓肠肌外侧头iEMG值、Fugl-Meyer下肢运动功能评分均显著高于康复组(均P<0.05),小腿三头肌肌张力显著低于康复组(P<0.05);治疗后,针康组患者足趾屈改善程度优良率为87.76%(43/49),显著高于康复组的69.39%(34/49,P<0.05);针康组显效率为48.98%(24/49),显著高于康复组的28.57%(14/49,P<0.05)。结论:针刺结合康复训练治疗脑卒中后足下垂患者的临床效果优于单纯康复治疗。

Objective To compare the clinical efficacy difference between acupuncture combined with rehabilitation and simple rehabilitation for foot drop after stroke.Methods Ninety-eight patients were randomly divided into a combination group and a rehabilitation group,49 cases in each one.Acupuncture and rehabilitation were used in the combination group.The acupoints were Yanglingquan（GB 34）,Zusanli（ST 36）,Guangming（GB 37）,Xuanzhong（GB 39）,Sanyinjiao（SP 6）,etc.,while rehabilitation included training for musculi hippicus strength and musculi triceps surae.Only the same rehabilitation was applied in the rehabilitation group.The treatment was given six times a week for continuous six weeks.Musculi hippicus force,shank triceps spasticity,toe flexion improvement and the maximum integral EMG（iEMG）of the musculi tibialis anterior and caput laterale musculi gastrocnemii were compared between the two groups,and the effects were evaluated.Results After treatment,the musculi hippicus force,iEMG of musculi tibialis anterior and caput laterale musculi gastrocnemii,the function scores of the lower limbs by Fugl-Meyer of the two groups were better than those before treatment（all P〈0.05）,with the better effect in the combination group（all P〈0.05）.And the scores of shank triceps tension were decreased in the two groups（both P〈0.05）,more apparently for the combination therapy（P〈0.05）.The improvement rate of toe flexion of the combination group was 87.76%（43/49）,which was obviously higher than69.39%（34/49）of the rehabilitation group（P〈0.05）.The cured rate of the combination group was 48.98%（24/49）,and it was better than 28.57%（14/49）of the rehabilitation group（P〈0.05）.Conclusion Acupuncture combined with rehabilitation achieves better effect than simple rehabilitation for foot drop after stroke.