基于肌骨超声技术中药熏蒸精准论治中风偏瘫恢复期肩痛疗效观察
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摘要
目的:探讨基于肌骨超声技术下中药熏蒸精准论治中风偏瘫恢复期肩痛的疗效。方法:选择2017年1月—2018年5月常州市德安医院康复中心收治的中风后偏瘫肩痛患者160例,按照随机数字表法分为对照组与研究组,每组各80例。两组均给予中药熏蒸治疗,对照组常规理学检查确定明显疼痛或病变部位为治疗靶点,研究组采用肌骨超声仪明确病变部位并将此作为治疗靶点,两组均每日治疗1次,每次30 min,每周治疗5次,治疗6周为1个疗程。观察两组患者治疗前及治疗1周、3周、6周时视觉模拟疼痛评分(VAS)、Fugl-Meyer上肢运动功能评分情况,比较治疗前与治疗6周时两组患者患侧肩关节被动活动度变化情况。结果:不同治疗时间在VAS评分、Fugl-Meyer上肢运动评分上存在显著主效应(P<0.01),不同治疗方法在VAS评分、Fugl-Meyer上肢运动评分上存在显著主效应(P<0.01),不同治疗时间和治疗方法间在VAS评分、Fugl-Meyer上肢运动评分中存在交互作用(P<0.01);治疗后研究组患者患侧肩关节前屈、后伸、内旋、外旋与外展的被动活动度均明显大于同期对照组,差异有统计学意义(P<0.05)。结论:在肌骨超声技术支持下开展中药熏蒸治疗中风偏瘫肩痛,可显著提高中药熏蒸治疗中风偏瘫肩痛的疗效,大大促进上肢功能的恢复。
Objective:To explore the effect of fumigation of traditional Chinese medicine on shoulder pain during convalescence of hemiplegia after stroke. Methods:A total of 160 cases of patients with poststroke hemiplegia shoulder pain in rehabilitation center of Changzhou Dean hospital from January 2017 to May 2018,who were according to random number table method were divided into control group and research group,80 cases in each group. In the two groups were given traditional Chinese medicine fumigation treatment,control group was given routine physical examination to determine the obvious pain or therapeutic targets for the lesion site,The study group was used musculoskeletal ultrasonic technology to identify the lesion site and use it as a therapeutic target,two groups of treatment 1 times a day,every time 30 min,five times a week treatment,treatment of 6 weeks for a course of treatment. To observe two groups of patients before treatment and treatment for 1 week,3 weeks,6 weeks visual analog pain score(VAS),Fugl-Meyer upper limb movement function grading,compare before and 6 weeks treatment in the two groups patients suffering from passive side shoulder joint activity changes. Results:Different treatment time in VAS score,Fugl-Meyer had significant main effect on upper limb movement score(P<0.01),different treatment methods in the VAS score,Fugl-Meyer significant main effect on upper limb movement score(P<0.01),between the different treatment time and treatment in VAS score,Fugl-Meyer interaction existed in the upper limb movement score(P<0.01);After treatment,the passive activity of the patients in the study group was significantly higher than that of the control group(P<0.05). Conclusion:Under the support of musculoskeletal ultrasonic technology,traditional Chinese medicine fumigation can improve the curative effect on shoulder pain of stroke hemiplegia,and promote the recovery of upper limb function.
Objective:To explore the effect of fumigation of traditional Chinese medicine on shoulder pain during convalescence of hemiplegia after stroke. Methods:A total of 160 cases of patients with poststroke hemiplegia shoulder pain in rehabilitation center of Changzhou Dean hospital from January 2017 to May 2018,who were according to random number table method were divided into control group and research group,80 cases in each group. In the two groups were given traditional Chinese medicine fumigation treatment,control group was given routine physical examination to determine the obvious pain or therapeutic targets for the lesion site,The study group was used musculoskeletal ultrasonic technology to identify the lesion site and use it as a therapeutic target,two groups of treatment 1 times a day,every time 30 min,five times a week treatment,treatment of 6 weeks for a course of treatment. To observe two groups of patients before treatment and treatment for 1 week,3 weeks,6 weeks visual analog pain score(VAS),Fugl-Meyer upper limb movement function grading,compare before and 6 weeks treatment in the two groups patients suffering from passive side shoulder joint activity changes. Results:Different treatment time in VAS score,Fugl-Meyer had significant main effect on upper limb movement score(P<0.01),different treatment methods in the VAS score,Fugl-Meyer significant main effect on upper limb movement score(P<0.01),between the different treatment time and treatment in VAS score,Fugl-Meyer interaction existed in the upper limb movement score(P<0.01);After treatment,the passive activity of the patients in the study group was significantly higher than that of the control group(P<0.05). Conclusion:Under the support of musculoskeletal ultrasonic technology,traditional Chinese medicine fumigation can improve the curative effect on shoulder pain of stroke hemiplegia,and promote the recovery of upper limb function.
引文
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[11]Lo SF,Chen SY,Lin HC,et al. Arthrographic and clinical findings in patients with hemiplegic shoulder pain[J].Arch Phys Med Rehabil,2003,84(12):1786-1791.
[12]Barlak A,Unsal S,Kaya K,et al. Poststroke shoulder pain in Turkish stroke patients:relationship with clinical factors and functional outcomes[J].International Journal of Rehabilitation Research,2009,32(4):309-315.
[13]Karaahmet OZ,Eksioglu E,Gurcay E,et al. Hemiplegic shoulder pain:associated factors and rehabilitation outcomes of hemiplegic patients with and without shoulder pain[J].Top Stroke Rehabil,2014,2l(3):237-245.
[14]陈烨文,许琳,龚一萍,等.论“六经中风”的证治特点[J].浙江中医药大学学报,2015,39(2):92-94.
[15]邵玉玲,万全庆,谭同才.Bobath疗法结合中药熏蒸治疗偏瘫肩痛疗效观察[J].浙江中医杂志,2017,52(7):532-533.
[16]van Kampen DA,van den Berg T,van der Woude HJ,et al. The diagnosticvalue of the combination of patient characteristics,history,and clinical should tests for the diagnosis of rotator cuff tear[J].J Orthop Surg Res,2014,9:70.
[17]李铁山.肌骨超声与肩痛康复诊疗的动态可视化[J].中国康复医学杂志,2017,32(10):1098-1100.
[2]李林海,苏莉,宋秀媛,等.论中风后肩痛与元气及局部络病的关系[J].国际中医中药杂志,2015,37(9):837-839.
[3]何俊,谈雪梅,彭冬祥,等.中药熏蒸与冲击波联合治疗脑卒中后偏瘫肩痛疼痛改善及上肢功能康复疗效观察[J].辽宁中医药大学学报,2018,20(5):125-128.
[4]Corazza A,Orlandi D,Fabbro E,et al. Dynamic high—resolution ultrasound of the shoulder:How we do it[J].European Journal of Radiology,2015,84(2):266-277.
[5]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行)[J].北京中医药大学学报,1996,19(1):55-56.
[6]中华人民共和国卫生部医政司.中国康复医学诊疗规范[M].北京:华夏出版社,1998:76-82.
[7]赵亚平,赵晋平,胡文江,等.肩周炎患者肩关节囊的超声生理测值及影像特征分析研究[J].新疆医科大学学报,2012,35(8):1092-1095.
[8]Bailey LB,Beattie PF,Shanley E,et al. Current rehabilitation applications for shoulder ultrasound imaging[J].Journal of Orthopaedic&Sports Physical Therapy,2015,45(5):1-44.
[9]雪晴,卢漫.肩周疾病的影像学诊断研究进展[J].实用医院临床杂志,2015,12(3):195-197.
[10]Mohamed RE,Amin MA,Aboelsafa AA. Ultrasonographic and clinical study of post—stroke painful hemiplegic shoulder[J].The Egyptian Journal of Radiology And Nuclear Medicine,2014,45(4):1163-1170.
[11]Lo SF,Chen SY,Lin HC,et al. Arthrographic and clinical findings in patients with hemiplegic shoulder pain[J].Arch Phys Med Rehabil,2003,84(12):1786-1791.
[12]Barlak A,Unsal S,Kaya K,et al. Poststroke shoulder pain in Turkish stroke patients:relationship with clinical factors and functional outcomes[J].International Journal of Rehabilitation Research,2009,32(4):309-315.
[13]Karaahmet OZ,Eksioglu E,Gurcay E,et al. Hemiplegic shoulder pain:associated factors and rehabilitation outcomes of hemiplegic patients with and without shoulder pain[J].Top Stroke Rehabil,2014,2l(3):237-245.
[14]陈烨文,许琳,龚一萍,等.论“六经中风”的证治特点[J].浙江中医药大学学报,2015,39(2):92-94.
[15]邵玉玲,万全庆,谭同才.Bobath疗法结合中药熏蒸治疗偏瘫肩痛疗效观察[J].浙江中医杂志,2017,52(7):532-533.
[16]van Kampen DA,van den Berg T,van der Woude HJ,et al. The diagnosticvalue of the combination of patient characteristics,history,and clinical should tests for the diagnosis of rotator cuff tear[J].J Orthop Surg Res,2014,9:70.
[17]李铁山.肌骨超声与肩痛康复诊疗的动态可视化[J].中国康复医学杂志,2017,32(10):1098-1100.