小针刀松解肌筋膜触发点治疗脑卒中后痉挛性瘫痪35例临床观察

Clinical observation on 35 cases of spastic paralysis after stroke treated by needle scalpel in relaxing and promoting triggering spot of muscular fascia

目的观察小针刀松解肌筋膜触发点治疗脑卒中后痉挛性瘫痪的临床疗效。方法将78例脑卒中后痉挛性瘫痪患者采用随机数字表法分为治疗组和对照组,各39例,其中治疗组实际完成治疗及观察的患者共35例,对照组共36例。治疗组予小针刀松解肌筋膜触发点治疗,2 d治疗1次,5次为1个疗程,共治疗3个疗程;对照组予毫针针刺治疗,每日1次,连续治疗10 d为1个疗程,共治疗3个疗程。治疗后比较2组的临床疗效及治疗前后的Ashworth肌张力分级、临床痉挛指数(CSI)、日常生活能力量表(ADL)评分、简易运动功能评定量表(FMA)评分。结果治疗组总有效率为91.4%,对照组为66.7%,2组比较差异有统计学意义(P<0.05);治疗后2组Ashworth肌张力分级、CSI明显降低,FMA、ADL评分明显升高,与同组治疗前比较差异均有统计学意义(P<0.05),且治疗组对各项指标的改善作用明显优于对照组,2组治疗后比较差异均有统计学意义(P<0.05)。结论小针刀松解肌筋膜触发点可明显降低脑卒中后痉挛性瘫痪患者的肌张力及肢体痉挛程度,改善肢体运动功能,提高日常生活能力,作用优于毫针针刺治疗,疗效确切,值得临床推广应用。

Objective To observe the clinical efficacy of needle scalpel in relaxing and promoting triggering spot of muscular fascia in the treatment of spastic paralysis after stroke.Methods Seventy-eight cases of spastic paralysis after stroke were divided into treatment group and control group according to random number table method,with 39 cases in each.The cases of patients in the treatment group who actually completed the treatment and observation was 35,and those in the control group was 36.The treatment group was given needle scalpel in relaxing and promoting triggering spot of muscular fascia in the treatment of spastic paralysis after stroke.The treatment was once every 2 days,and 5 times constituted one course of treatment,a total of 3 courses of treatment.The control group was treated with filiform needle acupuncture once a day for 10 days as a course of treatment,a total of 3 courses of treatment.After treatment,the clinical efficacy and Ashworth muscular tension grading,clinic spasticity index(CSI),activity of daily living(ADL)and Fugl-Meyer assessment(FMA)scores before and after treatment of the two groups were compared.Results The total effective rate of the treatment group was 91.4%,that of the control group was66.7%,there was statistically significant difference between the two groups(P<0.05).After treatment,Ashworth muscular tension grading and CSI of the two groups significantly decreased,while FMA and ADL scores significantly increased,there was statistically significant difference compared with the same group before treatment(P<0.05),moreover,the improvement of each index in the treatment group was better than that in the control group,there was statistically significant difference between the two groups after treatment(P<0.05).Conclusion Needle scalpel in relaxing and promoting triggering spot of muscular fascia can markedly decrease the muscular tension and the spasm degree of the limbs of the patients with spastic paralysis after stroke,enhance the ability of limb movement,improve the ability of daily life,the effect is better than the filiform needle acupuncture treatment,the curative effect is accurate,which is worthy of clinical promotion and application.