针刺治疗中风后下肢痉挛状态的临床观察
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摘要
研究背景
中风后痉挛是中风常见的后遗症,有多种不同的临床表现,包括肢体运动能力丧失,关节挛缩变形,并严重影响患者行走功能及日常活动。缓解肢体痉挛状态对于中风患者来说非常重要。许多研究报道表明针灸能够有效控制痉挛,但是没有数据化指标来证实疗效。
材料与方法
本研究将60例中风患者随机分为针灸组(治疗组)和康复训练组(对照组)2组。两组患者每周均治疗5次,疗程4周。观察指标：改良的Ashworth量表(MAS),临床痉挛指数量表(CSI),Barthel量表(B1),足印分析,及患者自我评价量表(PRO)。所有患者均来自北京中医药大学东直门医院。
研究结果
治疗4周后,两组治疗后较治疗前CSl分值显著降低(P<0.005),但是针灸组与康复组CSl分值变化的组间比较有显著性差异(P<0.05),针灸组优康复组。
下肢Ashworth量表评分明显下降,针灸治疗组,踝关节Ashworth评分由治疗前的2.73±0.82降至治疗后的1.86±0.81；膝关节Ashworth评分由治疗前2.33±0.66降至治疗后的1.6±0.49。针灸组与康复组组间有显著性差异,针灸组优于康复组(P<0.05)。
两组Brathel量表评分均提高,针灸组较康复组提高显著(P<0.05)。足印分析表明：两组患者患侧与健侧步长差均显著缩小,针灸组疗效更加显著(P<0.05)。针灸组更有效改善足长与矫正步角(P<0.05)。针灸组仅治疗1周患者步长与步角就出现改善,且改善明显优于康复组(P<0.05)。
针灸组与康复组在步宽的改善上不明显。针灸组与康复组均使患者行走速度加快,但两组间没有显著性差异。针灸组有50%患者对治疗结果非常满意,康复组仅有6.7%对疗效非常满意,康复组有53%患者对疗效比较满意。
结论
针灸可显著改善中风后肢体痉挛状态,改善行走功能,和步态参数。可作为安全有效的治疗手段推荐给中风患者。足印分析是经济、有效的临床评价方法。
Back ground:Muscle spasticity is a common disability syndrome after a stroke. It can manifest itself in different ways, including the loss of free movement of a limb, joint contracture and can severely affects the normal walking ability and activities of daily life. Reducing the spasticity is often an important problem in the management of patients after stroke. Many studies reported different findings about the effectiveness of acupuncture to control spasticity but its efficacy had not been proven yet with a comprehensive study.
Material and methods:In this clinical trial we randomly divided 60 patients with post stroke spasticity into two groups:acupuncture (treatment group) and physiotherapy (control group). All of the patients received their treatment five times per week during four weeks. The outcome measures used were:the Modified Ashworth Scale (MAS), the Clinical Spasm Index (CSI), the Barthel Index (BI), gait and foot print analysis, and Patient-reported Outcomes (PROs). This study was conducted at the Dongzhimen Hospital of Beijing University of Chinese Medicine.
Result:Both therapeutic methods significantly decreased the CSI of the participants at the end of the treatment(P<0.005),however acupuncture was significantly more effective to decrease the CSI after 4 weeks of treatment(P<0.05).
The average of Ashworth Scale for lower limb significantly decreased from 2.73±0.82 before treatment to 1.86±0.81 after acupuncture treatment (ankle joint), and from 2.33±0.66 to 1.6±0.49 (knee joint) for treatment group. There were significant differences noted between the treatment group and the control group after intervention and acupuncture was significantly more effective (P<0.05).
Both groups showed an improvement in Barthel Index. However, the improvement in acupuncture group was better than the control group (P<0.05). Our findings in the foot print analysis showed that both treatments significantly decreased the difference of step length between affected and unaffected sides but acupuncture was significantly more effective (P< 0.05).Acupuncture showed better effects of improvement of the foot length and correction of the foot angle(P<0.05). Therapeutic effects on step length and foot angle just after one week of treatment were also significantly higher in the acupuncture group (P<0.05). Each of the two treatments decreased the stride width during walking but the difference between the two groups was not significant. Acupuncture and physiotherapy both increased the gait speed and there was no significant difference between them.50% of the patients were very satisfied about the outcome of acupuncture at the end of treatment course whereas 53% of the patients in physiotherapy group were moderately satisfied of the results in the end of their treatment.
Conclusion:Acupuncture is significantly effective in reducing spasticity in post stroke patients, and could improve walking ability and gait parameters. It could thus be recommended as a safe and effective therapeutic method for post stroke patients. Besides, foot print analysis is a clinical and economical measurement method to evaluate of spasticity.
中风后痉挛是中风常见的后遗症,有多种不同的临床表现,包括肢体运动能力丧失,关节挛缩变形,并严重影响患者行走功能及日常活动。缓解肢体痉挛状态对于中风患者来说非常重要。许多研究报道表明针灸能够有效控制痉挛,但是没有数据化指标来证实疗效。
材料与方法
本研究将60例中风患者随机分为针灸组(治疗组)和康复训练组(对照组)2组。两组患者每周均治疗5次,疗程4周。观察指标：改良的Ashworth量表(MAS),临床痉挛指数量表(CSI),Barthel量表(B1),足印分析,及患者自我评价量表(PRO)。所有患者均来自北京中医药大学东直门医院。
研究结果
治疗4周后,两组治疗后较治疗前CSl分值显著降低(P<0.005),但是针灸组与康复组CSl分值变化的组间比较有显著性差异(P<0.05),针灸组优康复组。
下肢Ashworth量表评分明显下降,针灸治疗组,踝关节Ashworth评分由治疗前的2.73±0.82降至治疗后的1.86±0.81；膝关节Ashworth评分由治疗前2.33±0.66降至治疗后的1.6±0.49。针灸组与康复组组间有显著性差异,针灸组优于康复组(P<0.05)。
两组Brathel量表评分均提高,针灸组较康复组提高显著(P<0.05)。足印分析表明：两组患者患侧与健侧步长差均显著缩小,针灸组疗效更加显著(P<0.05)。针灸组更有效改善足长与矫正步角(P<0.05)。针灸组仅治疗1周患者步长与步角就出现改善,且改善明显优于康复组(P<0.05)。
针灸组与康复组在步宽的改善上不明显。针灸组与康复组均使患者行走速度加快,但两组间没有显著性差异。针灸组有50%患者对治疗结果非常满意,康复组仅有6.7%对疗效非常满意,康复组有53%患者对疗效比较满意。
结论
针灸可显著改善中风后肢体痉挛状态,改善行走功能,和步态参数。可作为安全有效的治疗手段推荐给中风患者。足印分析是经济、有效的临床评价方法。
Back ground:Muscle spasticity is a common disability syndrome after a stroke. It can manifest itself in different ways, including the loss of free movement of a limb, joint contracture and can severely affects the normal walking ability and activities of daily life. Reducing the spasticity is often an important problem in the management of patients after stroke. Many studies reported different findings about the effectiveness of acupuncture to control spasticity but its efficacy had not been proven yet with a comprehensive study.
Material and methods:In this clinical trial we randomly divided 60 patients with post stroke spasticity into two groups:acupuncture (treatment group) and physiotherapy (control group). All of the patients received their treatment five times per week during four weeks. The outcome measures used were:the Modified Ashworth Scale (MAS), the Clinical Spasm Index (CSI), the Barthel Index (BI), gait and foot print analysis, and Patient-reported Outcomes (PROs). This study was conducted at the Dongzhimen Hospital of Beijing University of Chinese Medicine.
Result:Both therapeutic methods significantly decreased the CSI of the participants at the end of the treatment(P<0.005),however acupuncture was significantly more effective to decrease the CSI after 4 weeks of treatment(P<0.05).
The average of Ashworth Scale for lower limb significantly decreased from 2.73±0.82 before treatment to 1.86±0.81 after acupuncture treatment (ankle joint), and from 2.33±0.66 to 1.6±0.49 (knee joint) for treatment group. There were significant differences noted between the treatment group and the control group after intervention and acupuncture was significantly more effective (P<0.05).
Both groups showed an improvement in Barthel Index. However, the improvement in acupuncture group was better than the control group (P<0.05). Our findings in the foot print analysis showed that both treatments significantly decreased the difference of step length between affected and unaffected sides but acupuncture was significantly more effective (P< 0.05).Acupuncture showed better effects of improvement of the foot length and correction of the foot angle(P<0.05). Therapeutic effects on step length and foot angle just after one week of treatment were also significantly higher in the acupuncture group (P<0.05). Each of the two treatments decreased the stride width during walking but the difference between the two groups was not significant. Acupuncture and physiotherapy both increased the gait speed and there was no significant difference between them.50% of the patients were very satisfied about the outcome of acupuncture at the end of treatment course whereas 53% of the patients in physiotherapy group were moderately satisfied of the results in the end of their treatment.
Conclusion:Acupuncture is significantly effective in reducing spasticity in post stroke patients, and could improve walking ability and gait parameters. It could thus be recommended as a safe and effective therapeutic method for post stroke patients. Besides, foot print analysis is a clinical and economical measurement method to evaluate of spasticity.
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