“金钩钓鱼”针法结合Bobath技术治疗脑卒中后上肢痉挛状态的临床研究

Clinical study of post-stroke upper limb spasmodic hemiplegia treated with jingou diaoyu needling technique and Bobath therapy

目的:比较"金钩钓鱼"针法结合Bobath技术与单纯运用Bobath技术治疗脑卒中后上肢痉挛状态的临床疗效差异。方法:将60例患者随机分为观察组和对照组,每组30例。两组均给予神经内科常规药物治疗,对照组采用Bobath易化技术进行康复训练,观察组在对照组治疗的基础上,选取中府、天府、尺泽、曲池、间使、大陵行"金钩钓鱼"针法。两组均每日治疗1次,5次为一疗程,共治疗4周。采用改良Ashworth痉挛分级、简式Fugl-Meyer运动评分量表(FMA)和Barthel指数(BI)对两组患者治疗前后的肌张力、上肢运动功能及日常生活活动能力进行评价,并比较两组临床疗效。结果:与治疗前比较,治疗后两组患者改良Ashworth痉挛分级、Fugl-Meyer评分和BI评分均有改善(均P<0.01),但观察组均优于对照组(均P<0.01);观察组临床总有效率为93.3%(28/30),优于对照组的80.0%(24/30,P<0.05)。结论:"金钩钓鱼"针法结合Bobath技术治疗脑卒中后上肢痉挛状态疗效优于单纯Bobath技术,可以有效缓解痉挛状态,改善上肢运动功能,提高日常生活能力。

Objective To compare the difference in the clinical efficacy on post-stroke upper limb spasmodic hemiplegia between the combined therapy of jingou diaoyu needling technique and Bobath technology and simple Bobath technology.Methods Sixty patients were randomized into an observation group and a control group,30 cases in each one.The usual medication of neurological internal medicine was used in the two groups.In the control group,Bobath facilitation technology was applied to the rehabilitation training.In the observation group,on the basis of the treatment as the control group,jingou diaoyu needling technique was used to stimulate Zhongfu（LU 1）,Tianfu（LU 3）,Chize（LU 5）,Quchi（LI 11）,Jianshi（PC 5）and Daling（PC 7）.The treatment was given once a day;5treatments made one session and totally 4-week treatment was required in the two groups.The modified Ashworth scale,the modified Fugle-Meyer assessment（FMA）and the Barthel index（BI）were adopted to evaluate the muscular tension,the upper limb motor function and the activities of daily living（ADL）before and after treatment in the two groups.The clinical efficacy was compared between the two groups.Results Compared with those before treatment,the modified Ashworth scale,Fugl-Meyer score and BI score were all improved after treatment in the two groups（all P〈0.01）.The results in the observation group were better than those in the control group（all P〈0.01）.The total clinical effective rate was 93.3%（28/30）in the observation group and was 80.0%（24/30）in the control group.The efficacy in the observation group was better than that in the control group（P〈0.05）.Conclusion The jingou diaoyu needling technique combined with Bobath therapy achieve the superior efficacy on poststroke upper limb spasmodic hemiplegia as compared with the simple application Bobath therapy.This combined treatment effectively relieve spasmodic state and improve the upper limb motor function and the activities of daily living.