针刺联合下肢康复训练治疗脑梗死后膝关节功能障碍临床观察

Clinical observation on acupuncture combined with lower limb rehabilitation training in the treatment of knee joint dysfunction after cerebral infarction

目的观察针刺联合下肢康复训练治疗脑梗死后膝关节功能障碍的临床疗效。方法将80例脑梗死后膝关节功能障碍患者按照随机数字表法分为2组。对照组39例予下肢康复训练,治疗组41例在对照组治疗基础上联合针刺治疗。2组均治疗30 d。比较2组疗效;观察2组治疗前后患侧下肢关节活动度(髋关节最大屈曲伸展角度、膝关节最大屈曲伸展角度、踝关节背屈跖屈活动角度)及步态参数步长、步宽、步频、步速变化;比较2组治疗前后下肢Fugl-Meyer评定量表(FMA)、改良Barthel指数(BI)评分、生活质量评分变化。结果治疗组总有效率87.80%(36/41),对照组总有效率64.10%(25/39),治疗组疗效优于对照组(P<0.05)。2组治疗后髋关节最大屈曲伸展角度、膝关节最大屈曲伸展角度及踝关节背屈跖屈活动角度均较本组治疗前增加(P<0.05),且治疗组增加更明显(P<0.05)。2组治疗后步长、步宽、步频及步速均较本组治疗前增加(P<0.05),且治疗组增加更明显(P<0.05)。2组治疗后下肢FMA、BI评分均较本组治疗前升高(P<0.05),且治疗组升高更明显(P<0.05)。2组治疗后生理、心理、社会及环境评分均较本组治疗前升高(P<0.05),且治疗组升高更明显(P<0.05)。结论针刺联合下肢康复训练治疗脑梗死后膝关节功能障碍,能增加患侧下肢关节活动度,改善步态,提高生活质量。

Objective To observe the effect of acupuncture combined with lower limb rehabilitation training in the treatment of knee joint dysfunction after cerebral infarction.Methods 80 patients with knee joint dysfunction after cerebral infarction were randomly divided into two groups according to the random number table method.39 cases in the control group were given lower limb rehabilitation training.41 cases in the treatment group were treated by acupuncture on the basis of the control group.Both groups were treated for 30 days.The curative effects of the two groups were compared.Before and after treatment,the range of motion of the affected lower limb joint(the maximum flexion and extension angle of hip joint,the maximum flexion and extension angle of knee joint,the angle of ankle joint dorsiflexion and plantar flexion),and the changes of gait parameters such as step length,step width,step frequency and stride speed were observed.The changes of Fugl Meyer rating scale(FMA)of lower limbs,modified barthel index(BI)and quality of life(QOL)were compared between the two groups before and after treatment.Results The total effective rate of the treatment group was 87.80%(36/41),and that of the control group was 64.10%(25/39).The curative effect of the treatment group was better than that of the control group(P<0.05).After treatment,the maximum flexion and extension angle of hip joint,maximum flexion and extension angle of knee joint and ankle joint dorsal flexion and plantar flexion angle of both groups were increased compared with those in the group before treatment(P<0.05),and the increase in treatment group was more obvious(P<0.05).After treatment,the step length,step width,step frequency and stride speed of the two groups were increased compared with those in the group before treatment(P<0.05),and the increase in the treatment group was more obvious(P<0.05).After treatment,FMA and BI scores of lower limbs in both groups were higher than those in the group before treatment(P<0.05),and the increase in treatment group was more obvious(P<0.05).After treatment,the scores of physiology,psychology,society and environment in both groups were higher than those in the group before treatment(P<0.05),and the increase in treatment group was more obvious(P<0.05).Conclusion Acupuncture combined with lower limb rehabilitation training in the treatment of knee joint dysfunction after cerebral infarction can increase the range of motion of lower limb joint,improve gait and improve the quality of life.