肌筋膜松解术治疗脑卒中后上肢痉挛性瘫痪的效果

Clinical study on myofascial release for the treatment of upper limb spastic paralysis after stroke

目的 探讨肌筋膜松解术治疗脑卒中后上肢痉挛性瘫痪(spastic paralysis after stroke),SPAS的临床疗效及对中枢神经系统的影响。方法 随机数字表法将100例于2023年1月至2024年3月浙江中医药大学附属第二医院就诊的上肢SPAS患者分为对照组(50例,采用常规治疗及普通针刺)、观察组(50例,采用常规治疗及肌筋膜松解术),通过比较两组治疗前后改良Ashworth痉挛量表(MAS)评分的变化以评估临床总有效率,同时比较两组简化Fugl-Meyer标准(FMA)评分、肌电F波以及血清γ-氨基丁酸(γ-aminobutytic acid,GABA)含量的变化。结果 观察组总有效率96%,对照组总有效率86%,差异无统计学意义(P=0.08),但治疗组显效率显著高于对照组(P<0.05);治疗后两组MAS评分均显著降低(P<0.001),且观察组评分的降低较对照组明显(P<0.05);治疗后两组FMA评分均显著升高(P<0.001),且观察组评分的升高显著高于对照组(P<0.05);治疗后两组肌电F波波幅均显著降低、阈值均显著升高(P<0.05),且观察组变化程度均显著高于对照组(P<0.05);治疗后两组血清GABA含量均显著下降(P<0.001),且观察组含量的降低显著高于对照组(P<0.001)。结论 相比于普通针刺,肌筋膜松解术治疗上肢SPAS能更好地改善肌张力、提高肢体运动功能,可促进中枢神经系统调控作用。

Objective To investigate the clinical efficacy of myofascial release in the management of upper limb spastic paralysis after stroke(SPAS)and its impact on the central nervous system.Methods The patients with upper limb spasticity who visited Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January 2023 to March 2024 were randomly divided into a control group(n=50)receiving conventional treatment and acupuncture,and a treatment group(n=50)receiving conventional treatment and myofascial release.The clinical response rate was assessed by comparing the modified Ashworth Spasticity Scale(MAS)scores between the two groups.Additionally,changes in simplified Fugl-Meyer Assessment(FMA)scores,electromyographic F-waves,and serum gamma-aminobutyric acid(GABA)levels were compared.Results The total effective rate of the treatment group was 96%,while that of the control group was 86%,showing no statistically significant difference(P=0.08).However,the effective rate in the treatment group was significantly higher than that in the control group(P<0.05).Following treatment,both groups exhibited a significant reduction in MAS scores(P<0.001),with a notably greater decrease observed in the observation group compared to the control group(P<0.05).Moreover,after treatment,there was a significant increase in FMA scores for both groups(P<0.05),and this increase was significantly more pronounced in the observation group than in the control group(P<0.05).After treatment,both groups exhibited a significant reduction in electromyographic F-waves amplitude and a significant increase in threshold(P<0.05).Moreover,the observation group demonstrated a significantly greater degree of change compared to the control group(P<0.05).Following treatment,serum GABA levels significantly decreased in both groups(P<0.001),with the observation group showing a markedly higher decrease than the control group(P<0.001).Conclusion In comparison to conventional acupuncture,myofascial release demon⁃strates superior efficacy in improving muscle tension and limb motor function for the treatment of upper limb SPAS,while also facilitating central nervous system regulation.