东垣针法对缺血性脑卒中后偏瘫患者运动功能及皮质脊髓束损伤的影响研究

Effect of Dongyuan Needling on Motor Function and CST Injury in Patients with Hemiplegia after Ischemic Stroke

目的:观察东垣针法对缺血性脑卒中后偏瘫患者运动功能及皮质脊髓束(CST)损伤的影响。方法:选择2020年1月—2021年3月接诊的128例缺血性脑卒中后偏瘫患者,采用随机数字表法随机分为对照组和观察组各64例。对照组予常规药物和康复治疗,观察组在对照组治疗基础上联合东垣针法治疗,连续治疗8周。在治疗前1 d及治疗结束后1 d,采用改良Ashworth痉挛评定量表(MAS)、Fugl-Meyer运动功能量表(FMA)、改良Barthel指数(MBI)、Berg平衡量表(BBS)、起立-行走计时测试(TUGT)进行运动功能评定,使用MRI弥散张量成像技术检测患侧及健侧CST的各向异性分数(FA),计算患侧与健侧FA比值(rFA),根据弥散张量纤维束成像结果进行CST损伤评分。结果:观察组治疗后腕屈肌、肘屈肌、膝伸肌和踝屈肌的MAS评分均低于对照组,差异具有统计学意义(P<0.05);观察组治疗后FMA评分、MBI评分均高于对照组,差异具有统计学意义(P<0.05);观察组治疗后BBS评分高于对照组,TUGT时间短于对照组,差异具有统计学意义(P<0.05);观察组治疗后rFA大于对照组,CST损伤评分低于对照组,差异具有统计学意义(P<0.05)。结论:东垣针法治疗缺血性脑卒中后偏瘫的效果较好,能有效改善患者的运动功能,促进CST损伤恢复。

Objective:To observe the effects of Dongyuan needling on motor function and corticospinal tract(CST)injury in patients with hemiplegia after ischemic stroke.Methods:A total of 128 patients with hemiplegia after ischemic stroke were randomly divided into the control group and the observation group,with 64 cases in each group.The control group was given conventional medication and rehabilitation training;on which basis,the observation group was also treated with Dongyuan needling.The treatment duration was 8 weeks in both groups.One day before and one day after the treatment,motor function was assessed by modified Ashworth Spasmodic Rating Scale(MAS),Fugl-Meyer Motor Function Scale(FMA),modified Barthel Index(MBI),Berg Balance Scale(BBS),and standing up and walking Time test(TUGT).The fractional anisotropy(FA)of CST on the affected side and the healthy side was measured by MRI diffusion tensor imaging,and the ratio of FA on the affected side and the healthy side(rFA)was calculated.The CST injury score was calculated according to the results of the diffusion tensor fiber bundle imaging.Results:The MAS scores of wrist flexor,elbow flexor,knee extensor and ankle flexor were significantly lower in the observation group than those in the control group(P<0.05).The FMA score and the MBI score were higher in the observation group than those in the control group after the treatment(P<0.05).The BBS score was higher and the TUGT was shorter in the observation group than those in the control group(P<0.05).The rFA was higher and the CST injury score was lower in the observation group than those in the control group(P<0.05).Conclusion:Dongyuan needling has a better curative effect in treatment of hemiplegia after ischemic stroke,which can effectively improve motor function and promote recovery of CST injury.