巨刺法结合康复训练治疗中风后肩手综合征Ⅲ期的临床研究

Clinical Study of Contralateral Meridian Needling Combined with Rehabilitation Training Treating SHS of Stage Ⅲ after Stroke

目的:观察采用巨刺法结合康复训练治疗中风后肩手综合征(SHS)Ⅲ期患者临床疗效,为进一步推广该综合疗法的临床应用提供科学依据。方法:共纳入120例患者,按照简单随机数字法分为巨刺康复组、单纯康复组和常规针刺组,每组各40例,3组均接受内科基础治疗,单纯康复组给予肢体康复训练治疗,常规针刺组予针刺患侧穴位,巨刺康复组在单纯康复组治疗的基础上予针刺健侧穴位,疗程均为4周。采用视觉模拟评分(VAS)法、简化Fugl-Meyer运动功能评分(FMA)法和日常生活能力评分(BI)法评价疗效。结果:巨刺康复组总有效率达92.31%,而单纯康复组及常规针刺组分别为41.02%与43.59%,3组总有效率比较巨刺康复组优于其他两组,差异具有统计学意义(P<0.05)。治疗后巨刺康复组VAS评分均低于单纯康复组及常规针刺组,差异均有统计学意义(P<0.05);而巨刺康复组FMA评分及BI评分分别与单纯康复组及常规针刺组相比,差异均无统计学意义(P>0.05)。结论:与单纯康复训练及常规针刺疗法相比,巨刺法结合康复训练更能有效地缓解中风后肩手综合征Ⅲ期患者患肢的疼痛,但却未能有效地改善患肢运动功能,同时也未能有效地提高患者的日常生活能力,提示早期诊断与治疗才是SHS康复的关键所在。

Objective： To observe the clinical efficacy of contralateral meridian needling combined with rehabilitation training in treatment of stage Ⅲ of shoulder-hand syndrome（ SHS） after stroke,so as to provide scientific basis for further promoting the clinical application of this comprehensive therapy. Methods： A total of120 patients were randomly divided into the group of contralateral meridian needling combined with rehabilitation training（ C-R group）,the simple rehabilitation group（ R group）,and the routine acupuncture group（ A group）,with 40 patients in each group. The three groups received basic medical treatment; on which basis,R group was given limb rehabilitation training; A group was treated with needling affected side; C-R group was treated with needling uninjuried side combined with rehabilitation training. The treatment course was 4 weeks.Scores of VAS,FMA and BI were used to evaluate the therapeutic effect. Results： The total effective rate was92. 31% in C-R group,which was significantly higher than 41. 02% in R group and 43. 59% in A group（ P〈0. 05）. The VAS score after treatment was significantly lower in C-R group than that in R group and in A group（ P〈0. 05）. There were no statistical differences in scores of FMA and BI between C-R group and R group,as well as between C-R group and A group（ P〉0. 05）. Conclusion： Contralateral meridian needling combined with rehabilitation training can effectively relieve the shoulder pain in patients with SHS after stroke,compared to simple rehabilitation training and routine acupuncture therapy. However,the motor function of affected limb and daily living ability of the patients were not effectively improved,which suggests that early diagnosis and treatment is the key factor in SHS rehabilitation.