手足十二穴捻转平补泻手法结合重复经颅磁刺激对缺血性卒中偏瘫患者肢体肌力的影响

Effects of Twirling Manipulation for Reinforcing and Reducing of Twelve Acupoints on Hands and Feet Combined with rTMS on Limb Muscle Strength in Patients with Ischemic Stroke and Hemiplegia

目的探讨手足十二穴捻转平补泻手法结合重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对缺血性卒中偏瘫患者肢体肌力的影响。方法选取2020年12月—2021年12月医院收治的102例缺血性卒中偏瘫患者为研究对象,以随机数字表法分研究组、对照组,各51例。对照组给予常规治疗联合rTMS,研究组在对照组的基础上给手足十二穴捻转平补泻手法治疗,连续治疗4周后观察效果。记录两组中医症状评分、临床疗效,对比两组上下肢体肌力及运动、平衡功能。结果两组治疗后的主症、次症中医证候评分均低于治疗前(P<0.05),研究组治疗后的主症、次症中医证候评分均低于对照组(P<0.05)。研究组总有效率高于对照组(P<0.05)。两组治疗前的上肢肌力分级情况对比差异无统计学意义(P>0.05),两组治疗后的上肢肌力分级优于治疗前(P<0.05),研究组治疗后的上肢肌力分级优于对照组(P<0.05)。两组治疗前的下肢肌力分级情况对比差异无统计学意义(P>0.05),两组治疗后的下肢肌力分级优于治疗前(P<0.05),研究组治疗后的下肢肌力分级优于对照组(P<0.05)。两组治疗前的Fugl-Meyer运动功能量表(Fugl-meyer assessment,FMA)评分、Berg平衡量表(Berg balance scale,BBS)评分对比差异无统计学意义(P>0.05),两组治疗后的FMA评分、BBS评分均高于治疗前(P<0.05),研究组治疗后的FMA评分、BBS评分均高于对照组(P<0.05)。结论手足十二穴捻转平补泻手法结合rTMS治疗缺血性卒中偏瘫患者可增强疗效,改善其肢体肌力,促进肢体运动功能、平衡能力恢复。

Objective To investigate the effect of twisting manipulation for reinforcing and reducing of twelve acupoints of hands and feet combined with repetitive transcranial magnetic stimulation(rTMS)on limb muscle strength in patients with ischemic stroke and hemiplegia.Methods A total of 102 patients with ischemic stroke and hemiplegia who were admitted to the hospital from December 2020 to December 2021 were selected as the research objects,and divided into the study group and the control group by random number table method,with 51 cases in each.The control group was given conventional treatment combined with rTMS,and the study group was additionally given the twisting manipulation for reinforcing and reducing of twelve acupoints of hands and feet on the basis of the control group,and the effect was observed after 4 weeks of continuous treatment.The traditional Chinese medicine symptom scores and clinical efficacy of the two groups were recorded,and the muscle strength,movement and balance functions of the upper and lower limbs were compared between the two groups.Results The traditional Chinese medicine syndrome scores of the main symptoms and secondary symptoms in the two groups after treatment were lower than those before treatment(P<0.05)and the scores of the study group were significantly lower than those of the control group(P<0.05).The total effective rate of the study group was higher than that of the control group(P<0.05).There was no significant difference in the upper limb muscle strength classification between the two groups before treatment(P>0.05).The upper limb muscle strength classification in the two groups after treatment was better than that before treatment(P<0.05)and the upper limb muscle strength classification of the study group was better than that of the control group(P<0.05).There was no significant difference in the grading of lower extremity muscle strength between the two groups before treatment(P>0.05).The lower limb muscle strength classification after treatment in the two groups was better than that before treatment(P<0.05),and the lower limb muscle strength classification in the study group after treatment was better than that in the control group(P<0.05).There was no significant difference in Fugl-Meyer Motor Function Scale(FMA)score or Berg Balance Scale(BBS)score between the two groups before treatment(P>0.05).After treatment,the FMA score and BBS score in the two groups were higher than those before treatment(P<0.05)and the scores of the study group after treatment were higher than those of the control group(P<0.05).Conclusion The twisting manipulation for reinforcing and reducing of twelve acupoints of hands and feet combined with rTMS in the treatment of patients with ischemic stroke and hemiplegia can enhance the therapeutic effect,significantly improve the limb muscle strength,and promote the recovery of limb motor function and balance ability.