毫火针牵拉滞针术治疗卒中后足下垂的临床观察
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摘要
目的:比较毫火针牵拉滞针术与常规针刺治疗脑卒中后足下垂的效果,为其治疗方案的优化提供参考依据。方法:将60例脑卒中后足下垂患者随机分为治疗组和对照组,每组30例。对照组采取常规针刺,取患侧太冲、解溪、丘墟、悬钟、下巨虚、丰隆、上巨虚、足三里、犊鼻、承山及阿是穴,平补平泻,留针30min,1次/d,每周6次,共治疗4周。治疗组采用毫火针牵拉滞针术的治疗手法,取穴、治疗时间及疗程同对照组。治疗前后分别对2组患者进行改良Lovett肌力测定法评分、改良Ashworth量表评分、改良的Barthel指数评分、Holden步行评定量表评分、Fugl-Meyer下肢运动功能评分和足下垂改善情况评估(参照Garceau标准),并评价疗效。结果:与治疗前比较,治疗后两组患者改良Ashworth量表评分均降低(P<0.01),且治疗组降低幅度高于对照组(P<0.01)。治疗后两组患者Lovett肌力测定、改良的Barthel指数、Holden步行评定量表及Fugl-Meyer下肢运动功能评分均升高(P<0.01),且治疗组升高幅度高于对照组(P<0.01);治疗组足下垂改善情况的优良率为86.67%(26/30),高于对照组的66.67%(20/30),但差异无统计学意义(P>0.05)。结论:毫火针牵拉滞针术和常规针刺对脑卒中后足下垂均有效,毫火针牵拉滞针术的临床疗效更佳。
Objective To compare the therapeutic effect of fire-needling plus stuck-needle-stretching and conventional acupuncture for post-stroke foot drop,so as to provide a reference foundation for optimizing clinical treatment regimen.Methods A total of60 patients with post-stroke foot drop were equally randomized into a treatment group and a control group.In the treatment group,fire-needling plus stuck-needle-stretching was applied to acupoint pairs Jiexi(ST41)-Taichong(LR3),Xiajuxu(ST39)-ST41,Fenglong(ST40)-ST39,shangjuxu(ST37)-ST40,Zusanli(ST36)-ST37,Dubi(ST35)-ST36,Xuanzhong(GB39)-Qiuxu(GB40)on the affected side,and Chengshan(BL57)and Ashi points were swiftly pricked with red-hot filiform needle without needle retaining.In the conventional acupuncture group,the same acupoints were needled with filiform needles,and the treatment for both groups was given once a day,6 times a week,for consecutive 4 weeks.The spasm severity of posterior triceps of the lower leg was evaluated using modified Ashworth scale,the tibial anterior muscle strength was measured using Lovett'and Martin's methods,the activities of daily living were assessed using modified Barthel's index,the walking ability was evaluated using Holden walking rating scale and the lower limb motor function assessed using Fugl-Meyer assessment scale,and the severity of foot drop was assessed in reference to Garceau criteria.Results After the treatment,the score of the modified Ashworth scale was significantly reduced(P<0.01),and those of Lovett muscle strength scale,Barthel index,Holden walking rating scale and FuglMeyer lower limb motor function scale were considerably increased in both groups versus their own pre-treatment(P<0.01).The therapeutic effect of the treatment group was significantly superior to that of the control group in reducing Ashworth scale score and in increasing the scores of Lovett muscle strength test,Barthel index,Holden walking function scale and Fugl-Meyer lower limb motor function scale(P<0.01).Of the two 30 cases in the control and treatment groups,10(33.33%)and 14(46.67%)experienced a remarkable improvement,10(33.33%)and 12(40.00%)were improved,7(23.33%)and 3(10.00%)had a mild progress,3(10.00%)and 1(3.33%)failed,with the excellent plus good effective rates being 66.67% and 86.67%,respectively,but without significant difference between the two groups(P>0.05).Conclusion Both fire-needling plus stuck-needlestretching and conventional acupuncture are effective in the treatment of post-stroke foot drop,but the former is relatively better.
Objective To compare the therapeutic effect of fire-needling plus stuck-needle-stretching and conventional acupuncture for post-stroke foot drop,so as to provide a reference foundation for optimizing clinical treatment regimen.Methods A total of60 patients with post-stroke foot drop were equally randomized into a treatment group and a control group.In the treatment group,fire-needling plus stuck-needle-stretching was applied to acupoint pairs Jiexi(ST41)-Taichong(LR3),Xiajuxu(ST39)-ST41,Fenglong(ST40)-ST39,shangjuxu(ST37)-ST40,Zusanli(ST36)-ST37,Dubi(ST35)-ST36,Xuanzhong(GB39)-Qiuxu(GB40)on the affected side,and Chengshan(BL57)and Ashi points were swiftly pricked with red-hot filiform needle without needle retaining.In the conventional acupuncture group,the same acupoints were needled with filiform needles,and the treatment for both groups was given once a day,6 times a week,for consecutive 4 weeks.The spasm severity of posterior triceps of the lower leg was evaluated using modified Ashworth scale,the tibial anterior muscle strength was measured using Lovett'and Martin's methods,the activities of daily living were assessed using modified Barthel's index,the walking ability was evaluated using Holden walking rating scale and the lower limb motor function assessed using Fugl-Meyer assessment scale,and the severity of foot drop was assessed in reference to Garceau criteria.Results After the treatment,the score of the modified Ashworth scale was significantly reduced(P<0.01),and those of Lovett muscle strength scale,Barthel index,Holden walking rating scale and FuglMeyer lower limb motor function scale were considerably increased in both groups versus their own pre-treatment(P<0.01).The therapeutic effect of the treatment group was significantly superior to that of the control group in reducing Ashworth scale score and in increasing the scores of Lovett muscle strength test,Barthel index,Holden walking function scale and Fugl-Meyer lower limb motor function scale(P<0.01).Of the two 30 cases in the control and treatment groups,10(33.33%)and 14(46.67%)experienced a remarkable improvement,10(33.33%)and 12(40.00%)were improved,7(23.33%)and 3(10.00%)had a mild progress,3(10.00%)and 1(3.33%)failed,with the excellent plus good effective rates being 66.67% and 86.67%,respectively,but without significant difference between the two groups(P>0.05).Conclusion Both fire-needling plus stuck-needlestretching and conventional acupuncture are effective in the treatment of post-stroke foot drop,but the former is relatively better.
引文
[1]王建晖.智能助行仪对脑卒中足下垂患者步行功能的改善作用[J].中国临床新医学,2016,9(4):321-323.
[2]黄怡,万新炉,潘翠环,等.功能性电刺激对脑卒中足下垂患者步行能力的影响[J].神经损伤与功能重建,2014,9(3):231-232.
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[4]国家中医药管理局脑病急症协作组.中风病诊断疗效评定标准[J].北京中医药大学学报,1996,19(1):55-56.
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[14]凌振芬,鲁佑瑜.妙纳治疗34例脑卒中后肢体痉挛性瘫痪的临床观察[J].中国临床神经科学,2000,8(2):156-157.
[15]纪树荣.运动疗法技术学[M].北京:华夏出版社,2004:301-415.
[16]吴强,柳秀琴,杜菽,等.颅脑损伤后足下垂的康复治疗疗效观察[J].中国伤残医学,2010,18(1):20-21.
[17]王俊棠.矫形踝关节托对脑损伤致足下垂及足内翻偏瘫患者的影响[J].中华物理医学与康复杂志,2006,28(7):486-487.
[18]王英,高松,李筠.电子生物反馈疗法在脑卒中偏瘫患者中的应用[J].现代中西医结合杂志,2008,17(15):2340-2341.
[19]杨榕,曲崇正,庞维萍,等.针灸配合推拿治疗中风痉挛性偏瘫的临床研究[J].按摩与导引,2005,21(10):7-8.
[20]王亚锋.中医按摩结合现代康复训练对中风病偏瘫痉挛状态的疗效观察[D].北京:北京中医药大学,2003.
[21]王子臣,王声强.丘墟透照海治疗脑卒中足下垂60例疗效观察[J].河北中医药学报,2009,24(3):40-41.
[22]周昭辉,庄礼兴,徐展琼,等.靳三针配合康复训练治疗缺血性中风偏瘫疗效观察[J].上海针灸杂志,2011,30(4):214-216.
[23]雷从杰,杨浠,宋立军.踝三针治疗中风后足下垂的临床观察[J].中国中医急症,2014,23(8):1517-1519.
[24]唐容达,欧阳八四.恢刺配合康复训练治疗脑卒中后足下垂疗效观察[J].上海针灸杂志,2015,34(4):300-302.
[25]栾青.点按金门穴配合康复治疗和患肢管理预防脑卒中后足下垂[J].中西医结合心脑血管病杂志,2011,9(8):1011-1012.
[26]钱立锋.醒脑开窍针法联合康复训练治疗脑卒中后足下垂的临床观察[J].中国中医药科技,2016,23(3):325-326.
[2]黄怡,万新炉,潘翠环,等.功能性电刺激对脑卒中足下垂患者步行能力的影响[J].神经损伤与功能重建,2014,9(3):231-232.
[3]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经内科杂志,1996,29(6):379.
[4]国家中医药管理局脑病急症协作组.中风病诊断疗效评定标准[J].北京中医药大学学报,1996,19(1):55-56.
[5]王永炎,鲁兆麟.中医内科学[M].北京:人民卫生出版社,1999.
[6]沈雪勇.经络腧穴学[M].北京:中国中医药出版社,2003.
[7] BOHANNON R W,SMITH M B.Interrater reliability of a modified Ashworth scale of muscle spasticity[J].Phys Ther,1987,67(2):206-207.
[8]朱镛连,张皓,何静杰.神经康复学[M].北京:人民军医出版社,2001:227.
[9] SHAH S,VANCLAY F,COOPER B.Improving the sensitivity of the Barthel Index for stroke rehabilitation[J].J Clin Epidemiol,1989,42(8):703-709.
[10]燕铁斌.现代康复治疗学[M].广州:广东科技出版社,2004:43.
[11] GLADSTONE D J,DANELLS C J,BLACK S E.The FuglMeyer assessment of motor recovery after stroke:a critical review of its measurement properties[J].Neurorehabil Neural Repair,2002,16(3):232-240.
[12] GARCEAU G J,PALMER R M.Transfer of the anterior tibial tendon for recurrent club foot:a long-term follow-up[J].J Bone Joint Surg,1967,49(2):207-332.
[13]荣积峰,吴毅,顾玲,等.脑卒中患者足下垂和足内翻康复研究进展[J].中国康复,2015,30(1):45-48.
[14]凌振芬,鲁佑瑜.妙纳治疗34例脑卒中后肢体痉挛性瘫痪的临床观察[J].中国临床神经科学,2000,8(2):156-157.
[15]纪树荣.运动疗法技术学[M].北京:华夏出版社,2004:301-415.
[16]吴强,柳秀琴,杜菽,等.颅脑损伤后足下垂的康复治疗疗效观察[J].中国伤残医学,2010,18(1):20-21.
[17]王俊棠.矫形踝关节托对脑损伤致足下垂及足内翻偏瘫患者的影响[J].中华物理医学与康复杂志,2006,28(7):486-487.
[18]王英,高松,李筠.电子生物反馈疗法在脑卒中偏瘫患者中的应用[J].现代中西医结合杂志,2008,17(15):2340-2341.
[19]杨榕,曲崇正,庞维萍,等.针灸配合推拿治疗中风痉挛性偏瘫的临床研究[J].按摩与导引,2005,21(10):7-8.
[20]王亚锋.中医按摩结合现代康复训练对中风病偏瘫痉挛状态的疗效观察[D].北京:北京中医药大学,2003.
[21]王子臣,王声强.丘墟透照海治疗脑卒中足下垂60例疗效观察[J].河北中医药学报,2009,24(3):40-41.
[22]周昭辉,庄礼兴,徐展琼,等.靳三针配合康复训练治疗缺血性中风偏瘫疗效观察[J].上海针灸杂志,2011,30(4):214-216.
[23]雷从杰,杨浠,宋立军.踝三针治疗中风后足下垂的临床观察[J].中国中医急症,2014,23(8):1517-1519.
[24]唐容达,欧阳八四.恢刺配合康复训练治疗脑卒中后足下垂疗效观察[J].上海针灸杂志,2015,34(4):300-302.
[25]栾青.点按金门穴配合康复治疗和患肢管理预防脑卒中后足下垂[J].中西医结合心脑血管病杂志,2011,9(8):1011-1012.
[26]钱立锋.醒脑开窍针法联合康复训练治疗脑卒中后足下垂的临床观察[J].中国中医药科技,2016,23(3):325-326.