恢刺联合超声引导下冲击波对卒中后痉挛患者肌张力和运动功能的影响

Effects of relaxing needling plus ultrasound-guided shock wave on muscle tension and motor function in patients with post-stroke spasticity

目的观察恢刺联合超声引导下冲击波对卒中后痉挛(post-stroke spasticity,PSS)患者肌张力和运动功能的影响。方法将96例PSS患者随机分为观察组和对照组,每组48例。对照组给予超声引导下体外冲击波(extra-corporeal shock wave therapy,ESWT)治疗,观察组在对照组基础上采用恢刺阳陵泉穴治疗。观察两组治疗前后改良Ashworth量表(modified Ashworth scale,MAS)、Wolf运动功能测试(Wolf motor function test,WMFT)、功能综合评定(functional comprehensive assessment,FCA)量表、肌电均方根值(root mean square,RMS)和积分肌电值(integrated electromyogram,iEMG)变化。结果两组治疗后肌张力评分等级分布优于治疗前(P<0.05),且观察组等级分布优于对照组(P<0.05)。治疗后,两组WMFT评分均高于治疗前(P<0.05),且观察组高于对照组(P<0.05);两组FCA日常生活功能、认知功能及总分高于治疗前(P<0.05),且观察组高于对照组(P<0.05);两组RMS、iEMG低于治疗前(P<0.05),且观察组低于对照组(P<0.05)。结论恢刺联合超声引导下冲击波治疗PSS效果显著,可有效改善肌电生理指标、肌张力及运动功能,提高日常生活能力及认知水平。

Objective To observe the impact of relaxing needling plus ultrasound-guided shock wave on muscle tension and motor function in patients with post-stroke spasticity(PSS).Method A total of 96 PSS patients were randomized into an observation group and a control group,with 48 cases in each group.The control group received ultrasound-guided extra-corporeal shock wave therapy(ESWT),and the observation group received relaxing needling at Yanglingquan(GB34)in addition to the intervention for the control group.Before and after treatment,the modified Ashworth scale(MAS),Wolf motor function test(WMFT),functional comprehensive assessment(FCA),root mean square(RMS),and integrated electromyogram(iEMG)were observed for the two groups.Result The muscle tension grading distribution improved after treatment in both groups(P<0.05),and the observation group was superior to the control group(P<0.05).After intervention,the WMFT score increased in both groups(P<0.05)and was higher in the observation group than in the control group(P<0.05);the daily living function and cognitive function scores of FCA and the total score were higher than those before treatment in each group(P<0.05)and were higher in the observation group than in the control group(P<0.05);the RMS and iEMG decreased after treatment in both groups(P<0.05)and were lower in the observation group than in the control group(P<0.05).Conclusion Relaxing needling plus ultrasound-guided shock wave can produce significant efficacy in treating PSS;it can effectively improve electromyographic indexes,muscle tension,and motor function and enhance daily living capacity and cognitive level.