肩部强化训练联合穴位冲击波治疗偏瘫患者肩-手综合征的疗效观察

Curative Effect of Shoulder Intensive Training Combined with Acupoint Extracorporeal Shock Wave on Shoulder-Hand Syndrome in Hemiplegic Patients

目的:探讨肩部强化训练联合穴位冲击波治疗偏瘫患者肩-手综合征的临床疗效。方法:将90例偏瘫肩-手综合征患者按随机数字表法分为训练(TG)组、体外冲击波治疗(ESWT)组和综合治疗(CT)组各30例,三组患者均接受常规康复训练;在此基础上,TG组增加肩部强化训练,ESWT组增加穴位冲击波治疗,CT组增加肩部强化训练联合穴位冲击波治疗,在治疗前及治疗4周后采用上肢Fugl-Meyer(FMA)评分、疼痛和水肿程度评分进行疗效评估。结果:三组患者上肢FMA评分治疗后较治疗前有显著提高(P<0.001),疼痛和水肿则显著降低(PP<0.001);治疗后,三组上肢FMA、疼痛和水肿程度比较均有显著性差异(P<0.001);治疗后,CT组上肢FMA、疼痛及水肿程度较TG组、ESWT组改善更显著(P<0.001),TG组上肢FMA提高、水肿减轻较ESWT组有显著性差异(P<0.05),ESWT组疼痛较TG组改善更显著(P<0.05)。结论:肩部强化训练联合穴位冲击波治疗能显著缓解偏瘫患者肩-手综合征的临床症状,较单一疗法效果更好,为临床治疗提供了新的有效方法。

Objective:To investigate the curative effect of shoulder intensive training combined with acupoint extracorporeal shock wave on shoulder-hand syndrome(SHS)in hemiplegic patients.Methods:90 hemiplegic patients with SHS,in accordance with the random number table,were divided into training group(TG,n=30),extracorporeal shock wave therapy(ESWT)group(n=30)and comprehensive treatment(CT)group(n=30).All these three groups were treated with routine rehabilitation,while the TG group added shoulder intensive training,the ESWT group added acupoint extracorporeal shock wave therapy and the CT group added shoulder intensive training and acupoint extracorporeal shock wave therapy in addition.All the patients were assessed with Fugl-Meyer assessment(FMA)of the upper limbs,the degree of pain and edema before and after 4 weeks of the treatment.Results:Compared within groups:after the treatment,the FMA of the upper limbs improved significantly(P<0.001),while the pain and the edema decreased significantly(P<0.001)in these three groups.Compared among groups:the FMA,pain and edema were significant differences(P<0.001)among these three groups.Compared between any two groups:the FMA,pain and edema in the CT group were more notable improvement(P<0.001)than those in the TG group and the ESWT group.The FMA in the TG group was higher(P<0.05)than that in the ESWT group,while the edema in the TG group was lower(P<0.05)than that in the ESWT group.The pain in the ESWT group was lower(P<0.05)than that in the TG group.Conclusion:Treatment based on shoulder intensive training combined acupoint extracorporeal shock wave therapy can relieve symptoms of SHS,this method is better than monotherapy,which provides a new effective method for the treatment of SHS in hemiplegic patients.