镜像疗法结合通督醒神针法对脑卒中后上肢功能恢复的影响

Mirror therapy combined with acupuncture can improve the upper extremity function of stroke survivors

目的 探讨镜像疗法（MT）结合通督醒神针法对脑卒中患者上肢功能恢复的影响。 方法 选取60例脑卒中后上肢运动功能障碍患者，采用随机数字表法将其分为镜像组、针刺组及观察组。所有患者均给予常规康复治疗，镜像组、针刺组则分别辅以MT治疗或通督醒神针法治疗，观察组则同时辅以MT治疗及通督醒神针法治疗，持续治疗4周。于治疗前、治疗2周、4周后分别采用Fugl-Meyer运动功能评分（FMA）上肢部分、Brunnstrom上肢和手分期、Barthel指数（BI）、偏瘫侧腕背伸时主动关节活动度（AROM）对3组患者进行疗效评定。于治疗前、治疗4周后对观察组患者进行功能性磁共振成像（fMRI）检查。 结果 治疗2周、4周后3组患者上肢FMA评分、上肢及手Brunnstrom分期、偏瘫侧腕背伸AROM及BI评分均显著优于治疗前水平（P〈0.05）。组间比较发现，治疗2周、4周后观察组患者上肢FMA评分、上肢及手Brunnstrom分期、偏瘫侧腕背伸AROM均显著优于镜像组及针刺组（P〈0.05）；治疗2周后观察组BI评分显著优于针刺组（P〈0.05），治疗4周后观察组BI评分均显著优于镜像组及针刺组（P〈0.05）。6例观察组患者fMRI显示，治疗4周后其患侧初级运动区、运动前皮质区及辅助运动区均可见高强度激活区。 结论 镜像疗法联合通督醒神针法治疗脑卒中功能障碍患者具有协同作用，能进一步改善患者上肢运动功能，更有效提高患者日常生活活动能力，该联合疗法值得临床推广、应用。

Objective To explore the effects of mirror therapy combined with Tongdu Xingshen acupuncture on the upper extremity function of stroke survivors. Methods Sixty stroke survivors were randomly divided into a mirror group （n=20）, an acupuncture group （n=20） and a combined group （n=20）. In addition to routine rehabilitation treatment, those in each group received mirror therapy, acupuncture or both for 4 weeks. Before the treatment and after 2 and 4 weeks of treatment, all of the patients were assessed using the Fugl-Meyer motor function assessment （FMA）, Brunnstrom upper limb and hand staging （BSULH）, the Barthel Index （BI） and in terms of the active range of motion in the wrist contralateral to their hemiplegia （AROM）. The combined group was also evaluated using functional magnetic resonance imaging （fMRI） before treatment and after the 4 weeks. Results After 2 and 4 weeks of the treatment, the average BI, AROM, FMA and BSULH results had improved significantly compared with before the treatment. The improvements in the combined group were significantly greater than in the other groups after 2 and 4 weeks. The fMRI demonstrated that there were high-intensity signals in the primary motor area, the premotor area and the supplementary motor area on the affected side after 4 weeks of treatment. Conclusions Mirror therapy combined with Tungdu Xingshen acupuncture can improve the functional performance of the upper extremities of stroke survivors.