中医综合疗法结合康复运动训练治疗脑卒中后肩痛的临床观察

Clinical Observation of TCM Comprehensive Therapy Combined with Rehabilitation Exercise Training to Treat Post-Stroke Shoulder Pain

目的观察一种操作简单、易于推广的中医综合治疗方法结合康复运动训练对治疗脑卒中后肩痛的临床疗效。方法收集2021年7月—2022年12月间上海交通大学医学院附属仁济医院浦南分院中医科收治的脑卒中肩痛患者共80例,随机分配入组,最终脱落剔除6例,观察组36例,对照组38例。观察组予针刺、中药熏蒸、拔罐的中医综合疗法结合常规康复运动训练治疗,对照组予常规康复运动训练治疗,疗程为4周。主要观察两组病例的肩关节被动关节活动度(PROM)、视觉模拟评分法(VAS)评分;次要观察两组病例的上肢Fugl-Meyer运动及日常生活活动能力(Barthel指数)。结果治疗后,两组的肩关节PROM、VAS评分、BI评分均较治疗前改善(P<0.01,P<0.05),两组Fugl-Meyer评分与治疗前比较,差异无统计学意义(P>0.05)。治疗后,观察组在后伸、外旋2个方向疗效均优于对照组(P<0.01,P<0.05),观察组VAS评分低于对照组(P<0.01);观察组Fugl-Meyer及BI评分与对照组比较,差异无统计学意义(P>0.05)。结论中医综合疗法结合康复运动训练对治疗脑卒中后肩痛确有疗效,且在止痛及后伸、外旋方向的肩关节活动方面疗效优于单用基础治疗方案治疗,因其操作简单,可应用于临床推广。

Objective To observe the clinical efficacy of traditional Chinese medicine(TCM)comprehensive therapy combined with rehabilitation exercise training that is easy to operate and widely applied on post-stroke shoulder pain(PSSP).Methods A total of 80 patients with PSSP admitted to the Department of Traditional Chinese Medicine,Punan Branch of Renji Hospital,School of Medicine,Shanghai Jiaotong University,from July 2021 to December 202 were collected.Patients were randomly divided into different groups,but six patients were lost to follow-up.Finally,36 cases were included in the observation group,and 38 cases were included in the control group.The observation group received a combination of TCM comprehensive therapy including acupuncture,TCM fumigation,and cupping,as well as conventional rehabilitation exercise training,while the control group received conventional rehabilitation exercise training for four weeks.The passive range of motion(PROM)of the shoulder joint and visual analogue scale(VAS)were mainly observed in the two groups.Secondary observations were conducted on the upper limb Fugl-Meyer motion and activities of daily living(Barthel index,BI)of the two groups.Results After treatment,the PROM of the shoulder joint,VAS score,and BI score of the two groups improved(P<0.01,P<0.05),while the Fugl-Meyer score of the two groups showed no statistically significant difference compared to that before treatment(P>0.05).After treatment,the therapeutic effect of the observation group was better than that of the control group in both extension and external rotation directions(P<0.01,P<0.05),and the VAS score of the observation group was lower than that of the control group(P<0.01).There was no statistically significant difference in the Fugl-Meyer and BI scores between the observation group and the control group(P>0.05).Conclusion The TCM comprehensive therapy and rehabilitation exercise training are effective in the treatment of PSSP.Its therapeutic effect in pain relief and shoulder joint movement in the internal extension and external rotation directions is better than that of basic treatment alone.It can be applied to clinical promotion because of its convenient operation.