痉挛肌起止点浮针松解对脑卒中后肘关节屈曲痉挛的疗效观察

王小寅 文希 曾科学

【摘 要】 目的：观察痉挛肌起止点浮针松解对缓解脑卒中后肘关节屈曲痉挛的疗效。方法：将54例中风后肘关节屈曲痉挛患者随机分为对照组（传统针刺组）和治疗组（起止点浮针松解），每组各27例。两组均进行基础治疗及康复训练，对照组在基础治疗基础上采用传统针刺法，每日治疗1次，连续治疗4周；治疗组在基础治疗基础上采用起止点浮针松解法，隔日治疗1次，连续治疗4周。分别于治疗前、治疗后、随访（治疗后1月）对患者进行改良Ashworth量表（MAS）评定、Fugl-Meyer运动功能评定（FMA）、改良Barthel指数（BI）评定。结果：两组治疗后及随访时的MAS评分与治疗前相比，均有明显改善，且治疗组改善优于对照组（P<0.05）；FMA及BI评分显示两组在治疗后及随访时评分均较治疗前明显改善，治疗后两组之间差异无统计学意义（P>0.05），随访时治疗组疗效优于对照组（P<0.05）。结论：痉挛肌起止点浮针松解治疗可明显改善中风患者肘关节痉挛程度，且在改善痉挛及远期疗效方面优于传统针刺，值得临床推广应用。

【关键词】 起止点；浮针；传统针刺；脑卒中；痉挛

【中图分类号】K246 【文獻标志码】 A 【文章编号】1007-8517（2018）07-0077-03

Abstract：Objective To observe the effect of subcutaneous needle at original and terminal points for post-stroke spastic hemiplegia of elbow. Methods 54 patients with post-stroke spastic hemiplegia of elbow were randomly divided into the treatment group and the control group， 27 individuals in each. Boththe two groups received basic treatment and rehabilitation exercise. Based on the above treatment， subcutaneous needle at original and terminal points was given in the treatment group once every other day for 4 weeks and traditional acupuncture was given in the controlled group once daily for 4 weeks. Modified Ashworth scale， Fugl-Meyer motor function score and modified Barthel index （BI） were evaluated before、after 28-day treatment and during follow-up. Results MAS analysis indicated that both the 2 groups decreased the spasticity after treatment and during follow-up， and the treatment group was better than the control group. Both the 2 groups showed a significant difference in terms with FMA and BI score after treatment and during follow-up and it was better in treatment group than controlled group during follow-up， however， no difference was found after 28-day treatment. Conclusions Subcutaneous needle at original and terminal points could improve the symptom of post-stroke spastic hemiplegia of elbow， and it was better than traditional acupuncture in improving spasm and long-term effect.

Keywords：Original and Terminal Points； Subcutaneous Needle； Traditional Acupuncture； Stroke； Spasticity

脑卒中目前已成为严重威胁人类健康的全球性疾病之一，约有20%～40%的中风患者在后期罹患有肢体偏瘫痉挛[1]。肢体痉挛可导致肌肉僵硬、关节活动度下降、关节挛缩，严重影响患者的生活质量和后期肢体功能的恢复[2]。目前，缓解中风后肢体痉挛的方法主要包括药物治疗、矫形器、康复运动以及物理因子治疗等[3-4]，然而，经过上述治疗，仍有半数以上的患者未得到满意的疗效。因此，寻找一种更为安全、有效的方法显得尤为迫切。浮针疗法是一种新兴疗法，主要在病灶周围浅筋膜层（相当于传统经络理论的皮部）针刺，可以迅速改善局部循环，解除肌肉的痉挛。浮……