核心肌群运动揿针法配合肌电生物反馈疗法治疗卒中后肩关节半脱位临床观察

Clinical Observation of Core-muscle Motor Intradermal Needle Method Combined with Electromyographic Biofeedback Therapy for Post-stroke Shoulder Subluxation

目的观察核心肌群运动揿针法配合肌电生物反馈疗法治疗卒中后肩关节半脱位的临床疗效。方法选择卒中后肩关节半脱位患者120例,随机分为肌电组、联合组和揿针组,3组在常规治疗基础上,肌电组采用单纯的肌电生物反馈疗法,揿针组采用七星穴揿针埋入,联合组采用七星穴揿针埋入的运动针法配合肌电生物反馈疗法。比较3组治疗前以及治疗第3、6、9周的患者肌电积分值(i EMG)以及治疗前后的Fugl-Meyer上肢运动功能评分、Barthel指数、卒中特殊生活质量量表(SSQOLS)评分,并测量患侧肩峰与肱骨头间距(AHI)和两侧肩胛下角顶点间距。结果治疗第3周3组肌电积分值组内和组间比较差异均无统计学意义(P>0.05);治疗第6周,联合组组内比较差异有统计学意义(P<0.05),联合组与揿针组比较差异有统计学意义(P<0.05);治疗第9周,3组组内比较差异有统计学意义(P<0.05),联合组与揿针组、肌电组比较差异均有统计学意义(P<0.05)。治疗后3组Fugl-Meyer、Barthel评分以及AHI与治疗前比较差异均有统计学意义(P<0.05),联合组治疗后上述指标均优于肌电组和揿针组,差异有统计学意义(P<0.05);3组治疗后SSQOLS评分比较差异无统计学意义(P>0.05);治疗后3组疗效比较,联合组优于肌电组和揿针组,差异均有统计学意义(P<0.05)。结论采用揿针埋入七星穴联合核心肌群的个性化运动,再配合肌电生物反馈治疗,能有效改善患者肩痛和肩关节脱位情况,提高核心肌群的肌力和患者的运动功能。

Objective To observe the clinical efficacy of core-muscle motor intradermal needle method plus electromyographic biofeedback therapy in treating post-stroke shoulder subluxation.Method A total of 120 patients with post-stroke shoulder subluxation were recruited and randomized into an electromyography group,a combination group and an intradermal needle group.In addition to routine treatment,the electromyography group was given electromyographic biofeedback therapy,the intradermal needle group was given intradermal needle embedding at Qi Xing points,and the combination group was given motor needling of intradermal needle embedding at Qi Xing points plus electromyographic biofeedback therapy.The integrated electromyography(iEMG)was compared amongst the three groups before treatment and after 3-week,6-week and 9-week treatment;the Fugl-Meyer Assessment(FMA)score of upper-limb motor function,Barthel Index(BI)score,and Stroke-specific Quality of Life Scale(SSQOLS)score were compared before and after treatment;the acromiohumeral interval(AHI)of the affected side and the interval between the two inferior scapular angles were measured.Result In comparing the iEMG of the three groups,the intra-group and inter-group differences were all statistically insignificant at treatment week 3(P>0.05);at treatment week 6,the intra-group difference in the combination group was statistically significant(P<0.05),and the difference between the combination group and the intradermal needle group was statistically significant(P<0.05);at treatment week 9,the intra-group differences in the three groups were all statistically significant(P<0.05),and the combination group was significantly different from the intradermal needle group and the electromyography group(P<0.05).Regarding the FMA and BI scores and the measurement of AHI,the FMA and BI scores and AHI showed significant changes after treatment in the three groups(P<0.05),and the combination group was significantly better than the electromyography group and the intradermal needle group comparing the above indexes(P<0.05);the SSQOLS score did not show significant change after treatment in the three groups(P>0.05);in comparing the therapeutic efficacy after treatment,the combination group was better than the electromyography group and the intradermal needle group,with statistical significance(P<0.05).Conclusion Intradermal needle embedding at Qi Xing points combined with individualized core-muscle exercise plus electromyographic biofeedback can effectively improve shoulder pain and subluxation,and increase the core muscle strength as well as patient’s motor function.