针刺结合康复训练治疗脑卒中肩手综合征的临床研究
|
摘要
目的：观察针刺结合康复训练对脑卒中肩手综合征患者神经功能、上肢运动功能、疼痛及综合功能的影响,探讨针刺结合康复训练对脑卒中肩手综合征的治疗作用,为其在脑卒中肩手综合征临床治疗中的应用提供循证医学证据。
方法：在广州中医药大学第一附属医院住院病人中选取符合纳入标准的病例90例,按照随机化原则分为3组,依次为针刺组(A组)30例、康复训练组(B组)30例、针刺结合康复训练组(C组)30例,三组均每周治疗5天,休息2天后继续下一周治疗,共治疗4周,疗程28天。针刺组(A组)治疗日每天给予单纯针刺治疗一次、康复训练组(B组)治疗日每天给予单纯康复训练一次,针刺结合康复训练组(C组)治疗日每天给予针刺治疗与康复训练各一次。治疗期间三组均给予常规基础药物治疗28天。治疗前、治疗14天后及疗程结束后进行相关临床功能评定：神经功能评定采用临床神经功能缺损程度评分(NDS)、上肢运动功能评定采用上肢简化Fugl-Meyer评分(FMA)、上肢疼痛评定采用视觉模拟量表(VAS)、综合功能评定采用功能综合评定量表(FCA),疗程结束后进行肩手综合征综合疗效评定。
结果：各组患者年龄、性别及治疗前临床神经功能缺损程度评分、上肢简化Fugl-Meyer运动功能评分、上肢疼痛VAS评分、综合功能FCA评分比较,差异无统计学意义(P>0.05)。
1.NDS评分结果：各组治疗14天后、28天后NDS评分均明显下降,与治疗前比较均有显著性差异(P<0.01)。治疗14天后、28天后NDS评分下降值从高到低依次为针刺结合康复训练组(C组)、针刺组(A组)、康复训练组(B组),其中C组与A组之间比较差异无统计学意义(P>0.05),C组与B组、A组与B组之间比较差异有统计学意义(P<0.01)。
2.上肢简化FMA评分结果：各组治疗14天后、28天后上肢简化FMA评分均明显提高,与治疗前比较均有显著性差异(P<0.01)。治疗14天后、28天后上肢简化FMA评分升高值从高到低依次为C组、A组、B组,治疗14天后三组评分提高值之间比较差异无统计学意义(P>0.05),治疗28天后C组评分提高值显著高于B组(P<0.01),A组评分提高值也显著高于B组(P<0.05),C组与A组之间比较差异无统计学意义(P>0.05)。
3.VAS评分结果：各组治疗14天后、28天后VAS评分均明显下降,与治疗前比较均有显著性差异(P<0.01)。治疗14天后、28天后VAS评分下降值从高到低依次为C组、A组、B组,其中C组与A组之间比较差异无统计学意义(P>0.05),C组与B组、A组与B组之间比较差异有统计学意义(P<0.05或P<0.01)。
4.FCA评分结果：各组治疗14天后、28天后FCA评分均明显提高,与治疗前比较均有显著性差异。治疗14天后、28天后FCA评分升高值从高到低依次为C组、A组、B组,其中C组与A组之间比较差异无统计学意义(P>0.05),C组与B组、A组与B组之间比较差异有统计学意义(P＜0.01)。
5.肩手综合征综合疗效评定结果：A组显效率为26.7%,B组显效率为3.3%,C组显效率为36.7%,A组总有效率为90.0%,B组总有效率为83.3%,C组总有效率为96.7%,治疗效果由优到差依次为C组、A组、B组。C组与A组之间比较差异无统计学意义(P>0.05),C组与B组比较有显著性差异(P<0.01)、A组与B组比较有显著性差异(P<0.05)。
结论：对脑卒中肩手综合征患者采取针刺结合康复训练、单纯针刺、单纯康复训练的方法均能有效促进其神经功能的恢复、减轻其疼痛程度、改善其上肢运动功能及综合功能。针刺结合康复训练组疗效明显优于康复训练组,针刺结合康复训练组各项指标改善优于针刺组,虽然差异不显著,但两组之间的疗效差异有随治疗时间延长而放大的趋势。针刺与康复训练在脑卒中肩手综合征的治疗中具有良好的协同作用。
Objective To observe the effects of acupuncture combined with rehabilitation training on neurological function, upper limb motor function, pain degree, comprehensive function in the patients with shoulder-hand syndrome(SHS) after stroke. To study the therapeutic effects of acupuncture combined with rehabilitation training on SHS after stroke and to supply the evidence of its clinical application.
Methods All the cases were the inpatients of The First Affiliated Hospital of Guangzhou University of Chinese Medicine.90 cases of shoulder-hand syndrome after stroke enrolled according to inclusion criteria were randomized into three groups:the acupuncture group(group A), the rehabilitation training group (group B) and the acupuncture combined with rehabilitation training group (group C),30 cases in each group. Patients in the acupuncture group (group A) were treated only with acupuncture, patients in the rehabilitation training group (group B) were treated only with rehabilitation training, and the patients in acupuncture combined with rehabilitation training group (group C) were treated with both acupuncture and rehabilitation training. The treatment course lasted for 28 days, acupuncture and rehabilitation training were given five days a week, and basic drug therapy was given throughout the whole course in all the three groups. The three groups were evaluated before treatment,14 days after the treatment and after the whole treatment course. Neurological function was evaluated by Neural Dysfunction Scale (NDS), upper limb motor function was evaluated by Simplified Fugl-Meyer Assessment (FMA), pain degree was evaluated by Visual Analogue Scale (VAS), and comprehensive function was evaluated by Functional Comprehensive Assessment (FCA). The comprehensive effect was evaluated after the treatment course.
Results Before the treatment, there was no significant difference of age, sex, NDS score, Simplified FMA score, VAS score and FCA score between three groups (P>0.05)
1. Results of NDS:Compared with before treatment, the NDS scores decreased significantly both after 14 days of treatment and after the whole treatment course in all the three groups (P<0.01). By the reduced scores of NDS after 14 days of treatment and after the whole treatment course from higher to lower, three groups were sorted as:the acupuncture combined with rehabilitation training group (group C), the acupuncture group (group A) and the rehabilitation training group (group B). There was no significant difference between group C and group A (P>0.05). The difference was significant between group C and group B, as well as between group A and group B (P<0.01).
2. Results of Simplified FMA:Compared with before treatment, the Simplified FMA score increased significantly both after 14 days of treatment and after the whole treatment course in all three groups (P<0.01). By the increased scores of Simplified FMA after 14 days of treatment and after the whole treatment course from higher to lower, three groups were sorted as:group C, group A and group B. There was no significant difference between three groups after 14 days of treatment (P>0.05). The increased scores of group C was significantly higher than group B (P<0.01), and the increased scores of group A was also significantly higher than group B (P<0.05). There was no significant difference between group C and group A (P>0.05).
3. Results of VAS:Compared with before treatment, the VAS score decreased significantly after 14 days of treatment and after the whole treatment course in all the three groups (P<0.01). By the reduced scores of VAS after 14 days of treatment and after the whole treatment course from higher to lower, the three groups were sorted as:group C, group A and group B. There was no significant difference between group C and group A (P>0.05). The difference was significant between group C and group B (P<0.01), as well as between group A and group B (P<0.05).
4. Results of FCA:Compared with before treatment, the FCA score increased significantly both after 14 days of treatment and after the whole treatment course in all three groups (P<0.01). By the increased scores of FCA after 14 days of treatment and after the whole treatment course from higher to lower, the three groups were sorted as:group C, group A and group B. There was no significant difference between group C and group A (P>0.05), the difference was significant between group C and group B, as well as between group A and group B (P<0.01).
5. Results of the comprehensive effect evaluation:Apparent rate of the three groups was:group A 26.7%, group B 3.3% and group C 36.7%. Total effective rate of the three groups was:group A 90.0%, group B 83.3%, and group C 96.7%. By the effect of therapy from better to worse three groups were sorted as: group C, group A and group B. There was no significant difference between group C and group A (P>0.05), and the difference was significant between group C and group B (P<0.01), as well as between group A and group B (P<0.05).
Conclusion Acupuncture, rehabilitation training and acupuncture combined with rehabilitation training can all improve the neurological function, upper limb motor function and comprehensive function and release pain of patients with shoulder-hand syndrome after stroke. Acupuncture combined with rehabilitation training is significantly more effective than simple rehabilitation training. Although the difference was not significant, acupuncture combined with rehabilitation training improved the condition better than simple acupuncture, and the difference was more obvious as the treatment course extended. There is a synergetic effect of acupuncture and rehabilitation training in the therapy of SHS after stroke.
方法：在广州中医药大学第一附属医院住院病人中选取符合纳入标准的病例90例,按照随机化原则分为3组,依次为针刺组(A组)30例、康复训练组(B组)30例、针刺结合康复训练组(C组)30例,三组均每周治疗5天,休息2天后继续下一周治疗,共治疗4周,疗程28天。针刺组(A组)治疗日每天给予单纯针刺治疗一次、康复训练组(B组)治疗日每天给予单纯康复训练一次,针刺结合康复训练组(C组)治疗日每天给予针刺治疗与康复训练各一次。治疗期间三组均给予常规基础药物治疗28天。治疗前、治疗14天后及疗程结束后进行相关临床功能评定：神经功能评定采用临床神经功能缺损程度评分(NDS)、上肢运动功能评定采用上肢简化Fugl-Meyer评分(FMA)、上肢疼痛评定采用视觉模拟量表(VAS)、综合功能评定采用功能综合评定量表(FCA),疗程结束后进行肩手综合征综合疗效评定。
结果：各组患者年龄、性别及治疗前临床神经功能缺损程度评分、上肢简化Fugl-Meyer运动功能评分、上肢疼痛VAS评分、综合功能FCA评分比较,差异无统计学意义(P>0.05)。
1.NDS评分结果：各组治疗14天后、28天后NDS评分均明显下降,与治疗前比较均有显著性差异(P<0.01)。治疗14天后、28天后NDS评分下降值从高到低依次为针刺结合康复训练组(C组)、针刺组(A组)、康复训练组(B组),其中C组与A组之间比较差异无统计学意义(P>0.05),C组与B组、A组与B组之间比较差异有统计学意义(P<0.01)。
2.上肢简化FMA评分结果：各组治疗14天后、28天后上肢简化FMA评分均明显提高,与治疗前比较均有显著性差异(P<0.01)。治疗14天后、28天后上肢简化FMA评分升高值从高到低依次为C组、A组、B组,治疗14天后三组评分提高值之间比较差异无统计学意义(P>0.05),治疗28天后C组评分提高值显著高于B组(P<0.01),A组评分提高值也显著高于B组(P<0.05),C组与A组之间比较差异无统计学意义(P>0.05)。
3.VAS评分结果：各组治疗14天后、28天后VAS评分均明显下降,与治疗前比较均有显著性差异(P<0.01)。治疗14天后、28天后VAS评分下降值从高到低依次为C组、A组、B组,其中C组与A组之间比较差异无统计学意义(P>0.05),C组与B组、A组与B组之间比较差异有统计学意义(P<0.05或P<0.01)。
4.FCA评分结果：各组治疗14天后、28天后FCA评分均明显提高,与治疗前比较均有显著性差异。治疗14天后、28天后FCA评分升高值从高到低依次为C组、A组、B组,其中C组与A组之间比较差异无统计学意义(P>0.05),C组与B组、A组与B组之间比较差异有统计学意义(P＜0.01)。
5.肩手综合征综合疗效评定结果：A组显效率为26.7%,B组显效率为3.3%,C组显效率为36.7%,A组总有效率为90.0%,B组总有效率为83.3%,C组总有效率为96.7%,治疗效果由优到差依次为C组、A组、B组。C组与A组之间比较差异无统计学意义(P>0.05),C组与B组比较有显著性差异(P<0.01)、A组与B组比较有显著性差异(P<0.05)。
结论：对脑卒中肩手综合征患者采取针刺结合康复训练、单纯针刺、单纯康复训练的方法均能有效促进其神经功能的恢复、减轻其疼痛程度、改善其上肢运动功能及综合功能。针刺结合康复训练组疗效明显优于康复训练组,针刺结合康复训练组各项指标改善优于针刺组,虽然差异不显著,但两组之间的疗效差异有随治疗时间延长而放大的趋势。针刺与康复训练在脑卒中肩手综合征的治疗中具有良好的协同作用。
Objective To observe the effects of acupuncture combined with rehabilitation training on neurological function, upper limb motor function, pain degree, comprehensive function in the patients with shoulder-hand syndrome(SHS) after stroke. To study the therapeutic effects of acupuncture combined with rehabilitation training on SHS after stroke and to supply the evidence of its clinical application.
Methods All the cases were the inpatients of The First Affiliated Hospital of Guangzhou University of Chinese Medicine.90 cases of shoulder-hand syndrome after stroke enrolled according to inclusion criteria were randomized into three groups:the acupuncture group(group A), the rehabilitation training group (group B) and the acupuncture combined with rehabilitation training group (group C),30 cases in each group. Patients in the acupuncture group (group A) were treated only with acupuncture, patients in the rehabilitation training group (group B) were treated only with rehabilitation training, and the patients in acupuncture combined with rehabilitation training group (group C) were treated with both acupuncture and rehabilitation training. The treatment course lasted for 28 days, acupuncture and rehabilitation training were given five days a week, and basic drug therapy was given throughout the whole course in all the three groups. The three groups were evaluated before treatment,14 days after the treatment and after the whole treatment course. Neurological function was evaluated by Neural Dysfunction Scale (NDS), upper limb motor function was evaluated by Simplified Fugl-Meyer Assessment (FMA), pain degree was evaluated by Visual Analogue Scale (VAS), and comprehensive function was evaluated by Functional Comprehensive Assessment (FCA). The comprehensive effect was evaluated after the treatment course.
Results Before the treatment, there was no significant difference of age, sex, NDS score, Simplified FMA score, VAS score and FCA score between three groups (P>0.05)
1. Results of NDS:Compared with before treatment, the NDS scores decreased significantly both after 14 days of treatment and after the whole treatment course in all the three groups (P<0.01). By the reduced scores of NDS after 14 days of treatment and after the whole treatment course from higher to lower, three groups were sorted as:the acupuncture combined with rehabilitation training group (group C), the acupuncture group (group A) and the rehabilitation training group (group B). There was no significant difference between group C and group A (P>0.05). The difference was significant between group C and group B, as well as between group A and group B (P<0.01).
2. Results of Simplified FMA:Compared with before treatment, the Simplified FMA score increased significantly both after 14 days of treatment and after the whole treatment course in all three groups (P<0.01). By the increased scores of Simplified FMA after 14 days of treatment and after the whole treatment course from higher to lower, three groups were sorted as:group C, group A and group B. There was no significant difference between three groups after 14 days of treatment (P>0.05). The increased scores of group C was significantly higher than group B (P<0.01), and the increased scores of group A was also significantly higher than group B (P<0.05). There was no significant difference between group C and group A (P>0.05).
3. Results of VAS:Compared with before treatment, the VAS score decreased significantly after 14 days of treatment and after the whole treatment course in all the three groups (P<0.01). By the reduced scores of VAS after 14 days of treatment and after the whole treatment course from higher to lower, the three groups were sorted as:group C, group A and group B. There was no significant difference between group C and group A (P>0.05). The difference was significant between group C and group B (P<0.01), as well as between group A and group B (P<0.05).
4. Results of FCA:Compared with before treatment, the FCA score increased significantly both after 14 days of treatment and after the whole treatment course in all three groups (P<0.01). By the increased scores of FCA after 14 days of treatment and after the whole treatment course from higher to lower, the three groups were sorted as:group C, group A and group B. There was no significant difference between group C and group A (P>0.05), the difference was significant between group C and group B, as well as between group A and group B (P<0.01).
5. Results of the comprehensive effect evaluation:Apparent rate of the three groups was:group A 26.7%, group B 3.3% and group C 36.7%. Total effective rate of the three groups was:group A 90.0%, group B 83.3%, and group C 96.7%. By the effect of therapy from better to worse three groups were sorted as: group C, group A and group B. There was no significant difference between group C and group A (P>0.05), and the difference was significant between group C and group B (P<0.01), as well as between group A and group B (P<0.05).
Conclusion Acupuncture, rehabilitation training and acupuncture combined with rehabilitation training can all improve the neurological function, upper limb motor function and comprehensive function and release pain of patients with shoulder-hand syndrome after stroke. Acupuncture combined with rehabilitation training is significantly more effective than simple rehabilitation training. Although the difference was not significant, acupuncture combined with rehabilitation training improved the condition better than simple acupuncture, and the difference was more obvious as the treatment course extended. There is a synergetic effect of acupuncture and rehabilitation training in the therapy of SHS after stroke.
引文
[1]卓大宏.中国康复医学,北京：华夏出版社,2004：756.
[2]杨期东.神经病学,北京：人民卫生出版社,2002：118.
[3]南登崑.康复医学,北京：人民卫生出版社,2004：206-208.
[4]Davenport RJ, Dennis MS, Wellwood I, et al. Complications after acute stroke. Stroke,1996; 27(3):415-420.
[5]倪朝民.脑血管病的临床康复,合肥：安徽大学出版社,1998：29-33,178.
[6]缪鸿石.康复医学理论与实践,上海：上海科学技术出版社,2000：1840.
[7]缪鸿石,朱镛连.脑卒中的康复评定与治疗,北京：华夏出版社,1996：149-150.
[8]郭根平,沈丰庆,王珏,等,综合疗法治疗肩手综合征.中国康复,2005；20(2)：103.
[9]桑德春,杨晋.脑血管病后肩手综合征康复治疗的探讨.中国康复医学杂志,2003；18(10)：604-605.
[10]王茂斌.脑卒中的康复医疗,北京：中国科学技术出版社,2006：352-356.
[11]van Laere M, Claessens M. The treatment of reflex sympathetic dystrophy syndrome:current concepts. Acta Orthop Belg,1992; 58(Suppl1):259-261.
[12]韩仲岩,唐盛孟,石秉霞.实用脑血管病学,上海：上海科学技术出版社,1995：351-354.
[13]洪金标,李锐,翟伟.脑卒中后肩手综合征中西医研究综述.中华实用中西医杂志,2006；19(23)：2757-2759.
[14]王雨燕,王显达,麻虹.脑卒中后肩手综合征发病机制的研究进展.中西医结合心脑血管病杂志,2008；6(9)：1071-1072.
[15]Bobath B. Adult hemiplegia evaluation and treatment, London:William Heinemann Medical Books Limited,1985:27.
[16]过邦辅.骨折与关节损伤,上海：上海科学技术出版牡,1984：270-271.
[17]Joynt RL. The source of shouler pain in hemiplegia. Arch Phys Med Rdhabil, 1992; 73(5):409-413.
[18]倪朝民.偏瘫患者肩痛的康复.中国康复医学杂志,1993；8(4)：188.
[19]Veldman PH, Goris RJ. Shoulder complaints in patients with reflex sympathetic dystrophy of the upper extremity. Arch phys Med Rehabil,1995; 76(3):239-242.
[20]李津.急性脑血管病并发肩手综合征52例分析.广东医学,1997；18(11)：727.
[21]王崇顺.急性脑血管病下丘脑-垂体-靶腺轴变化的研究现状.中风与神经疾病杂志,1994；11(5)：316-318.
[22]Braverman DL, Kern HB, Nagler W. Recurrent spontaneous hemarthrosis associated with reflex sympathetic dystrophy. Arch Phys Med Rehabl,1998; 79(3):339-342.
[23]Steinbrocker 0. The shoulder-hand syndrome:present perspective. Arch Phys Med Rehabil,1968; 49(7):388-395.
[24]Kozin F, Ryan LM, Carerra GF, et al. The reflex sympathetic dytrophy syndrome(RSDS). III. Scintigraphic studies, further evidence for the therapeutic efficacy of systemic corticosteroids, and proposed diagnostic criteria. Am J Med,1981; 70(1):23-30.
[25]芦海涛.偏瘫后反射性交感神经营养不良研究进展.中国康复理论与实践,2006；12(1)：16-17.
[26]Cheng PT. Horg CZ. Prediction of reflex sympathetic dystrophy in hemiplegia patients by electromyographic study. Stroke,1995; 26(12): 2277-2280.
[27]周贤丽.肩手综合征的早期预防.第三军医大学学报,1994；16(2)：113.
[28]伍少玲,黄利荣,许俭兴.早期康复对脑卒中后肩手综合征患者上肢功能的影响.中国康复理论与实践,2002；8(1)：24.
[29]Hareau J. What makes treatment for reflex sympathetic dystrophy successful. J Hand Ther,1996; 9(4):367-370.
[30]张建宏,范建中,彭楠,等.综合康复治疗脑卒中后肩手综合征的疗效观察.中华物理医学与康复杂志,2005；27(9)：537-540.
[31]陈婵.治疗性体位预防重型脑卒中患肢早期并发症的探讨.护理学杂志,2000；15(8)：453-454.
[32]张继红,李雪松,田开语,等.早期康复对脑卒中后肩-手综合征患者上肢功能的影响.黑龙江医学,2006；30(9)：712-714.
[33]陈永华,黄蕤.综合治疗肩手综合征体会.现代中西医结合杂志,2007；16(9)：4018.
[34]Moon AH, Gragnani JA. Cold water immersion for the oedematous hand in stroke patients. Clin Rehabil,1989; 3(2):97.
[35]徐本华.肩-手综合征的康复.现代康复,1999；3(11)：1332-1334.
[36]刘秀,蒋丽莉.超早期康复护理防治偏瘫患者肩手综合征效果观察.护理学杂志,2006；21(1)：74-75.
[37]官崎东洋.反射性交感神经营养不良.日本医学介绍,2001；22(10)：436-437.
[38]Kondo I, Hosokawa K, Soma M, et al. Protocol to prevent shoulder-hand syndrome after stroke. Arch Phys Med Rehabil,2001; 82(11):1619-1623.
[39]崔晓,曾慧玲.脑卒中后肩手综合征.中国康复,2006；21(5)：344-345.
[40]张守效,梁秋兰,李风娟,等.双氯芬酸钠治疗脑血管病并肩手综合征19例疗效观察.工企医刊,1997；10(4)：19-20.
[41]Muizelaar JP, Kleyer M, Hertogs IA, et al. Complex regional pain syndrome (reflex sympathetic dystrophy and causalgia):management with the calcium channel blocker nifedipine and/or the alpha-sympathetic blocker phenoxybenzamine in 59 patients. Clin Neurol Neurosurg,1997; 99(1): 26-30.
[42]吴海青.氯胺酮在复杂的局部疼痛综合症治疗中的应用.岭南急诊医学杂志,2005；10(1)：30-31.
[43]Vuagnat H, Chantraine A. Shoulder pain in hemiplegia revisited: contribution of functional electrical stimulation and other therapies. J Rehabil Med,2003; 35(2):49-54.
[44]Yu DT, Chae J, Walker ME, et al. Percutaneous intramuscular neuromuscular electric stimulation for the treatment of shoulder subluxation and pain in patients with chronic hemiplegia:a pilot study. Arch Phys Med Rehabil, 2001; 82(1):20-25.
[45]陈昕,陈述荣,宋林.反射性交感神经营养不良的综合康复治疗.中国临床康复,2003,7(23)：3257.
[46]张云波.特定电磁波并药酒渗入治疗肩手综合征疗效观察.广西中医药,2004；27(2)：34.
[47]杨代和,张俐.脑卒中后肩-手综合征治疗相关研究的进展.现代中西医结合杂志,2008；17(1)：150-151.
[48]朱镛连.神经康复学,北京：人民军医出版社,2001：546.
[49]廖燕锬,林滨.脑卒中后肩-手综合征中西医治疗进展.中国康复理论与实践,2008；14(1)：41-42.
[50]林雪.针刺治疗中风后肩手综合征的疗效观察.针灸临床杂志,2007；23(4)：19.
[51]李金波,满斌.针刺治疗中风合并肩手综合征.中国中医基础医学杂志,2004；10(4)：48.
[52]赵晓峰,宋华.针刺治疗中风后肩手综合征30例临床观察.中国中医药信息杂志,2004；11(6)：532.
[53]王寅,杨涛,郭玉峰,等.不同针刺取穴方法结合系统康复治疗中风后肩手综合征疗效观察.中国针灸,2002；22(2)：83-85.
[54]于桂杰.应用体位、手法与针灸治疗脑卒中后肩手综合征34例.中国临床康复, 2004；8(13)：2524.
[55]陈沛卓.对脑卒中偏瘫后肩-手综合征的康复体会.现代康复,2001；5(4)：57.
[56]刘宝林,郭鲁义,王艳,等.头、体穴针刺结合康复技术治疗中风后肩手综合征的疗效观察.中华实用中西医杂志,2006；19(7)：748-749.
[57]张桂祥,姚凯.针刺推拿治疗脑卒中后肩-手综合征64例.陕西中医,2001；22(8)：984.
[58]王伟,秦爱国.巨刺法治疗肩手综合征镇痛疗效观察.广西中医药,1994；17(5)：6.
[59]李惠兰,胡万华.针药结合治疗肩-手综合征.针灸临床杂志,2002；18(9)：25-26.
[60]陈丽仪,郭元琦,凌楠,等.温电针治疗偏瘫后肩—手综合征28例.上海针灸杂志,2001；20(4)：33.
[61]夏晨.针刺治疗中风偏瘫肩手综合征26例——附甲襞微循环变化观察.辽宁中医,1998；25(7)：322-323.
[62]田洪文,高欣,于洪梅.脑卒中后肩手综合征治疗36例临床体会.航空航天医药,2005；16(2)：25.
[63]孙增强,李建川,朱守莲.电针治疗脑卒中后肩手综合征疗效分析.中国临床康复,2003；7(28)：3919.
[64]赵敬东,张萍.穴位注射治疗脑卒中后肩手综合征.辽宁中医杂志,2003；30(3)：209-210.
[65]郭严.穴位封闭治疗中风后肩手综合征疗效观察.吉林医学,2006；27(9)：1077-1078.
[66]阮传亮.三棱针点刺放血结合缠指法治疗肩手综合征54例.四川中医,2001；19(1)：67-68.
[67]江小荣.剌络拔罐并康复训练治疗中风后肩手综合征48例.浙江中医杂志,2005；40(2)：84.
[68]张彤,侯晓强.激光穴照加综和疗法治疗脑卒中肩-手综合征临床疗效观察.激光杂志,2004；25(3)：88.
[69]冀健民.火针配合按摩治疗中风后肩手综合征39例疗效观察.河北中医,2007；29(5)：444.
[70]许益强.耳针治疗偏瘫后肩手综合征30例临床观察.实用中医内科杂志,2003；17(6)：514.
[71]李燕梅,何双莉.独活寄生汤加味治疗脑卒中后肩手综合征76例疗效观察.河南中医,2004；24(11)：69-70.
[72]刘玉霞.补阳还五汤加味治疗肩-手综合征257例.新中医,2006；38(4)：76.
[73]郝凤玲,于存娟,姜林芳,等.辨证分型治疗肩手综合征38例.山东中医杂志, 2004；23(4)：211.
[74]凌方明.辨证治疗偏瘫后肩手综合征34例.中华实用中西医杂志,2001；14(1)：1879.
[75]姜华,孙承琪.中药局部浸渍加手法治疗肩手综合征32例.中国康复,2004；19(6)：374-374.
[76]李俊荣.加味三生酊治疗肩手综合征48例.河南中医,2001；21(3)：43.
[77]余恒旺,崔美莲,梁思杰,等.舒筋活络散治疗脑卒中后肩手征临床观察.中国中医急症,2006；15(9)：942.
[78]吴海科,顾卫,谭峰,等.舒筋洗药治疗脑卒中后肩手综合征42例.中医外治杂志,2004；13(6)：11.
[79]史玉香,孙建国,于智泉.脑卒中后肩手综合征早期疼痛中西医康复治疗的临床研究.泰山医学院学报,2006；27(3)：216-218.
[80]李庆生.中西医结合治疗急性脑血管病并发肩手综合征疗效观察.现代医药卫生,2003；19(12)：160.
[81]柴俊飞.推拿结合中药熏洗治疗卒中后肩手综合征临床体会.现代中西医结合杂志,2008；17(5)：722.
[82]刘运珠,张美花.针刺运动疗法治疗脑卒中并发肩手综合征60例.江苏中医药,2007；39(9)：54.
[83]张建国,徐悦泽.针灸结合康复治疗中风后肩手综合征80例.中国中医药科技,2008；15(2)：94.
[84]朱芬,陈尚杰,许琼瑜.康复训练与针刺有机组合对脑卒中肩手综合征FMA及BI的影响.中国康复,2009；24(3)：192.
[85]朱芬,陈尚杰,查思想.针刺配合康复训练对中风后肩手综合征疗效观察.上海针灸杂志,2009；28(5)：272-273.
[86]万裕萍,高宇飞.综合康复治疗脑卒中后肩手综合征的疗效观察.中华物理医学与康复杂志,2006；28(9)：647.
[87]陈鸣,针刺治疗脑卒中后肩-手综合症的临床观察.中国热带医学,2008；8(10)：1781.
[88]徐世芬,庄礼兴,贾超,等.靳三针疗法配合功能训练治疗中风偏瘫肩手综合征的临床观察.广州中医药大学学报,2010；27(1)：19-22.
[89]温静,张连城.调神通络法结合康复训练治疗卒中后肩手综合征30例临床观察.江苏中医药,2009；41(8)：55-56.
[90]刘远明.缪刺肩痛穴结合康复训练治疗肩手综合征的临床研究.甘肃医药,2009；28(3)：176-178.
[91]常娜,刘森.针灸结合康复训练治疗肩手综合征的疗效分析.第四军医大学学报, 2005；26(24)：2295-2297.
[92]史清钊,李春璐.电针对缓解肩手综合征腕部水肿与疼痛疗效的观察.航空航天医药,2007；18(1)：16-18.
[93]尚艳杰,马程程,蔡玉颖,等.针刺结合康复治疗中风后肩-手综合征.中国针灸,2008；28(5)：331-333.
[94]金瑛,汪军华,王爱君,等.针刺加康复训练治疗肩-手综合征40例疗效观察.针灸临床杂志,2007；23(1)：14-15.
[95]刘大建,张翔.针灸治疗反射性交感神经营养不良综合征的临床疗效.现代中西医结合杂志,2006；15(3)：326-327.
[96]唐强,张立雅,李晶.电针结合康复训练治疗脑卒中后肩-手综合征60例.针灸临床杂志,2005；21(4)：19-20.
[97]郭振强.针灸结合康复疗法治疗脑卒中后肩-手综合征40例.吉林中医药,2009；29(5)：416-417.
[98]中华神经学会.各类脑血管疾病诊断要点.中华神经科杂志,1996；29(6)：379-380.
[99]国家中医药管理局脑病急症科研协作组.中风病诊断和疗效评定标准.北京中医药大学学报,1996；(19)1：55.
[100]中华神经学会.脑卒中患者临床神经功能缺损程度评分标准(1995).中华神经科杂志,1996；29(6)：381-382.
[101]恽晓平.康复疗法评定学,北京：华夏出版社,2005：393-396.
[102]中华人民共和国卫生部医政司.中国康复医学诊疗规范(下册),北京：华夏出版社,1998：384.
[103]胡永善,吴毅,范文可,等.功能综合评定量表的研究(一)量表设计.中国康复医学杂志,2002；17(1)：35-38.
[104]王茂斌.偏瘫的现代评价与治疗,北京：华夏出版社,1990：226-231.
[105]陶子荣.我国脑卒中患者临床神经功能缺损评分标准信度、效度及敏感度的评价.第二军医大学学报,2009；30(3)：283-285.
[106]张通.脑卒中的功能障碍与康复.北京：科学技术文献出版社,2006：574.
[107]方军,胡永善.功能综合评定量表的信度与效度的初步研究.中华物理医学与康复杂志,2002；24(7)：424-425.
[108]范文可,胡永善,吴毅,等.功能综合评定量表效度的研究.中国康复医学杂志,2003；18(6)：325-329.
[109]朱镛连.脑卒中康复与神经康复机制.中国康复理论与实践,2003；9(3)：129-132.
[110]缪鸿石.中枢神经系统(CNS)损伤功能恢复的理论(一).中国康复理论与实 践,1995；1(1)：4.
[111]缪鸿石.中枢神经系统(CNS)损伤功能恢复的理论(八).中国康复理论与实践,1997；3(3)：103.
[112]Nelles G, Jentzen W, Jueptner M, et al. Arm training induced brain plasticity in stroke studied with serial positron emission tomography. Neuroimage,2001;13 (6 Pt 1):1146-1154.
[113]Levy CE, Nichols DS, Schmalbrock PM, et al. Functional MRI evidence of cortical reorganization in upper-limb stroke hemiplegia treated with constraint-induced movement therapy. Am J Phys Med Rehabil, 2001;80(1):4-11.
[114]倪朝民.脑卒中患者的肩部问题.现代康复,2000；4(4)：506-507.
[115]林文注.实验针灸学,上海：上海科学技术出版社,1994：44.
[116]彭力,李来支,彭锐,等.电针配合促通技术对急性脑卒中患者步行功能的影响.中国康复,2004；19(1)：26-27.
[117]石学敏.中风病与醒脑开窍针刺法,天津：天津科学出版社,2000：219-220.
[118]魏鹏绪.针刺治疗卒中后偏瘫的机理分析.中国康复理论与实践,2003；9(5)：300.
[119]木村研一.同时检测SSR和精神性出汗反应探讨针刺对皮肤交感神经功能的影响.国外医学·中医中药分册,1999；21(4)：38-39.
[120]Geertzen JH, Dijkstra PU, Groothoff JW, et al. Reflex sympathetic dystrophy of the upper extremity--a 5.5-year follow-up. Part Ⅰ. Impairments and perceived disability. Acta Orthop Scand Suppl,1998; 279:12-18.
[121]彭增福.靳三针疗法,上海：上海科学技术文献出版社,2000,第一版：16.
[122]李艳慧,靳瑞.三种不同针法治疗脑血管意外后遗症的研究.中国针灸,1993；13(4)：35-38.
[123]迪亚拉,靳瑞.“颞三针”治疗中风急性期的研究.针灸临床杂志,1995；11(8)：25-27.
[124]张雷,姚正业,纪春泓. “靳氏肩三针”与“传统肩三针”临床疗效比较后的体会.针灸临床杂志,1998；14(1)：1.
[125]卢佩斯,庄礼兴.中风偏瘫硬瘫期阴经刺法的应用.中华实用中西医杂志2005；18(22)：1643-1645.
[126]阮经文,罗仁翰.极泉穴合刺治疗中风后期肩关节活动功能障碍对照观察.广州中医学院学报,1995；12(1)：31-33.
[127]邢汝兰,朱富贵.按时针刺尺泽穴治疗脑梗死30例报告.中国临床康复,2002；6(7)：1036.
[128]楼新法,杨新东,戴开宇,等.尺泽穴断面桡神经定位及其意义.温州医学院学报,1998；28(1)：25-26.
[129]石学敏.以针灸治疗为中心的中风诊疗体系.江苏中医,1999；20(8)：3-4.
[130]石学敏.“醒脑开窍”针刺法治疗脑卒中.中国临床康复,2003；7(7)：1057-1058.
[131]庄捷,李天发.针刺结合运动疗法治疗中风后遗症78例.实徽中医临床杂志,2000；12(5)：385.
[132]殷汉贤,黄皖生,张德清,等.早期针刺推拿配合运动治疗中风偏瘫临床疗效分析.中国中西医结合急救杂志,2000；7(5)：302.
[133]史红斐.头体针结合运动疗法治疗脑卒中后遗症52例疗效观察.现代康复,2001；5(7)：118.
[134]闫喜莲,王文明,徐宝王.早期综合康复治疗急性脑卒中的疗效观察.中华物理医学与康复杂志,2004；23(10)：624.
[135]陈立典.偏瘫后肩手综合征的综合康复.中华理疗杂志,1997；20(1)：33.
[136]李响.112例中风偏瘫患者分组治疗的康复疗效分析.中国康复理论与实践,1997；3(1)：22-24.
[2]杨期东.神经病学,北京：人民卫生出版社,2002：118.
[3]南登崑.康复医学,北京：人民卫生出版社,2004：206-208.
[4]Davenport RJ, Dennis MS, Wellwood I, et al. Complications after acute stroke. Stroke,1996; 27(3):415-420.
[5]倪朝民.脑血管病的临床康复,合肥：安徽大学出版社,1998：29-33,178.
[6]缪鸿石.康复医学理论与实践,上海：上海科学技术出版社,2000：1840.
[7]缪鸿石,朱镛连.脑卒中的康复评定与治疗,北京：华夏出版社,1996：149-150.
[8]郭根平,沈丰庆,王珏,等,综合疗法治疗肩手综合征.中国康复,2005；20(2)：103.
[9]桑德春,杨晋.脑血管病后肩手综合征康复治疗的探讨.中国康复医学杂志,2003；18(10)：604-605.
[10]王茂斌.脑卒中的康复医疗,北京：中国科学技术出版社,2006：352-356.
[11]van Laere M, Claessens M. The treatment of reflex sympathetic dystrophy syndrome:current concepts. Acta Orthop Belg,1992; 58(Suppl1):259-261.
[12]韩仲岩,唐盛孟,石秉霞.实用脑血管病学,上海：上海科学技术出版社,1995：351-354.
[13]洪金标,李锐,翟伟.脑卒中后肩手综合征中西医研究综述.中华实用中西医杂志,2006；19(23)：2757-2759.
[14]王雨燕,王显达,麻虹.脑卒中后肩手综合征发病机制的研究进展.中西医结合心脑血管病杂志,2008；6(9)：1071-1072.
[15]Bobath B. Adult hemiplegia evaluation and treatment, London:William Heinemann Medical Books Limited,1985:27.
[16]过邦辅.骨折与关节损伤,上海：上海科学技术出版牡,1984：270-271.
[17]Joynt RL. The source of shouler pain in hemiplegia. Arch Phys Med Rdhabil, 1992; 73(5):409-413.
[18]倪朝民.偏瘫患者肩痛的康复.中国康复医学杂志,1993；8(4)：188.
[19]Veldman PH, Goris RJ. Shoulder complaints in patients with reflex sympathetic dystrophy of the upper extremity. Arch phys Med Rehabil,1995; 76(3):239-242.
[20]李津.急性脑血管病并发肩手综合征52例分析.广东医学,1997；18(11)：727.
[21]王崇顺.急性脑血管病下丘脑-垂体-靶腺轴变化的研究现状.中风与神经疾病杂志,1994；11(5)：316-318.
[22]Braverman DL, Kern HB, Nagler W. Recurrent spontaneous hemarthrosis associated with reflex sympathetic dystrophy. Arch Phys Med Rehabl,1998; 79(3):339-342.
[23]Steinbrocker 0. The shoulder-hand syndrome:present perspective. Arch Phys Med Rehabil,1968; 49(7):388-395.
[24]Kozin F, Ryan LM, Carerra GF, et al. The reflex sympathetic dytrophy syndrome(RSDS). III. Scintigraphic studies, further evidence for the therapeutic efficacy of systemic corticosteroids, and proposed diagnostic criteria. Am J Med,1981; 70(1):23-30.
[25]芦海涛.偏瘫后反射性交感神经营养不良研究进展.中国康复理论与实践,2006；12(1)：16-17.
[26]Cheng PT. Horg CZ. Prediction of reflex sympathetic dystrophy in hemiplegia patients by electromyographic study. Stroke,1995; 26(12): 2277-2280.
[27]周贤丽.肩手综合征的早期预防.第三军医大学学报,1994；16(2)：113.
[28]伍少玲,黄利荣,许俭兴.早期康复对脑卒中后肩手综合征患者上肢功能的影响.中国康复理论与实践,2002；8(1)：24.
[29]Hareau J. What makes treatment for reflex sympathetic dystrophy successful. J Hand Ther,1996; 9(4):367-370.
[30]张建宏,范建中,彭楠,等.综合康复治疗脑卒中后肩手综合征的疗效观察.中华物理医学与康复杂志,2005；27(9)：537-540.
[31]陈婵.治疗性体位预防重型脑卒中患肢早期并发症的探讨.护理学杂志,2000；15(8)：453-454.
[32]张继红,李雪松,田开语,等.早期康复对脑卒中后肩-手综合征患者上肢功能的影响.黑龙江医学,2006；30(9)：712-714.
[33]陈永华,黄蕤.综合治疗肩手综合征体会.现代中西医结合杂志,2007；16(9)：4018.
[34]Moon AH, Gragnani JA. Cold water immersion for the oedematous hand in stroke patients. Clin Rehabil,1989; 3(2):97.
[35]徐本华.肩-手综合征的康复.现代康复,1999；3(11)：1332-1334.
[36]刘秀,蒋丽莉.超早期康复护理防治偏瘫患者肩手综合征效果观察.护理学杂志,2006；21(1)：74-75.
[37]官崎东洋.反射性交感神经营养不良.日本医学介绍,2001；22(10)：436-437.
[38]Kondo I, Hosokawa K, Soma M, et al. Protocol to prevent shoulder-hand syndrome after stroke. Arch Phys Med Rehabil,2001; 82(11):1619-1623.
[39]崔晓,曾慧玲.脑卒中后肩手综合征.中国康复,2006；21(5)：344-345.
[40]张守效,梁秋兰,李风娟,等.双氯芬酸钠治疗脑血管病并肩手综合征19例疗效观察.工企医刊,1997；10(4)：19-20.
[41]Muizelaar JP, Kleyer M, Hertogs IA, et al. Complex regional pain syndrome (reflex sympathetic dystrophy and causalgia):management with the calcium channel blocker nifedipine and/or the alpha-sympathetic blocker phenoxybenzamine in 59 patients. Clin Neurol Neurosurg,1997; 99(1): 26-30.
[42]吴海青.氯胺酮在复杂的局部疼痛综合症治疗中的应用.岭南急诊医学杂志,2005；10(1)：30-31.
[43]Vuagnat H, Chantraine A. Shoulder pain in hemiplegia revisited: contribution of functional electrical stimulation and other therapies. J Rehabil Med,2003; 35(2):49-54.
[44]Yu DT, Chae J, Walker ME, et al. Percutaneous intramuscular neuromuscular electric stimulation for the treatment of shoulder subluxation and pain in patients with chronic hemiplegia:a pilot study. Arch Phys Med Rehabil, 2001; 82(1):20-25.
[45]陈昕,陈述荣,宋林.反射性交感神经营养不良的综合康复治疗.中国临床康复,2003,7(23)：3257.
[46]张云波.特定电磁波并药酒渗入治疗肩手综合征疗效观察.广西中医药,2004；27(2)：34.
[47]杨代和,张俐.脑卒中后肩-手综合征治疗相关研究的进展.现代中西医结合杂志,2008；17(1)：150-151.
[48]朱镛连.神经康复学,北京：人民军医出版社,2001：546.
[49]廖燕锬,林滨.脑卒中后肩-手综合征中西医治疗进展.中国康复理论与实践,2008；14(1)：41-42.
[50]林雪.针刺治疗中风后肩手综合征的疗效观察.针灸临床杂志,2007；23(4)：19.
[51]李金波,满斌.针刺治疗中风合并肩手综合征.中国中医基础医学杂志,2004；10(4)：48.
[52]赵晓峰,宋华.针刺治疗中风后肩手综合征30例临床观察.中国中医药信息杂志,2004；11(6)：532.
[53]王寅,杨涛,郭玉峰,等.不同针刺取穴方法结合系统康复治疗中风后肩手综合征疗效观察.中国针灸,2002；22(2)：83-85.
[54]于桂杰.应用体位、手法与针灸治疗脑卒中后肩手综合征34例.中国临床康复, 2004；8(13)：2524.
[55]陈沛卓.对脑卒中偏瘫后肩-手综合征的康复体会.现代康复,2001；5(4)：57.
[56]刘宝林,郭鲁义,王艳,等.头、体穴针刺结合康复技术治疗中风后肩手综合征的疗效观察.中华实用中西医杂志,2006；19(7)：748-749.
[57]张桂祥,姚凯.针刺推拿治疗脑卒中后肩-手综合征64例.陕西中医,2001；22(8)：984.
[58]王伟,秦爱国.巨刺法治疗肩手综合征镇痛疗效观察.广西中医药,1994；17(5)：6.
[59]李惠兰,胡万华.针药结合治疗肩-手综合征.针灸临床杂志,2002；18(9)：25-26.
[60]陈丽仪,郭元琦,凌楠,等.温电针治疗偏瘫后肩—手综合征28例.上海针灸杂志,2001；20(4)：33.
[61]夏晨.针刺治疗中风偏瘫肩手综合征26例——附甲襞微循环变化观察.辽宁中医,1998；25(7)：322-323.
[62]田洪文,高欣,于洪梅.脑卒中后肩手综合征治疗36例临床体会.航空航天医药,2005；16(2)：25.
[63]孙增强,李建川,朱守莲.电针治疗脑卒中后肩手综合征疗效分析.中国临床康复,2003；7(28)：3919.
[64]赵敬东,张萍.穴位注射治疗脑卒中后肩手综合征.辽宁中医杂志,2003；30(3)：209-210.
[65]郭严.穴位封闭治疗中风后肩手综合征疗效观察.吉林医学,2006；27(9)：1077-1078.
[66]阮传亮.三棱针点刺放血结合缠指法治疗肩手综合征54例.四川中医,2001；19(1)：67-68.
[67]江小荣.剌络拔罐并康复训练治疗中风后肩手综合征48例.浙江中医杂志,2005；40(2)：84.
[68]张彤,侯晓强.激光穴照加综和疗法治疗脑卒中肩-手综合征临床疗效观察.激光杂志,2004；25(3)：88.
[69]冀健民.火针配合按摩治疗中风后肩手综合征39例疗效观察.河北中医,2007；29(5)：444.
[70]许益强.耳针治疗偏瘫后肩手综合征30例临床观察.实用中医内科杂志,2003；17(6)：514.
[71]李燕梅,何双莉.独活寄生汤加味治疗脑卒中后肩手综合征76例疗效观察.河南中医,2004；24(11)：69-70.
[72]刘玉霞.补阳还五汤加味治疗肩-手综合征257例.新中医,2006；38(4)：76.
[73]郝凤玲,于存娟,姜林芳,等.辨证分型治疗肩手综合征38例.山东中医杂志, 2004；23(4)：211.
[74]凌方明.辨证治疗偏瘫后肩手综合征34例.中华实用中西医杂志,2001；14(1)：1879.
[75]姜华,孙承琪.中药局部浸渍加手法治疗肩手综合征32例.中国康复,2004；19(6)：374-374.
[76]李俊荣.加味三生酊治疗肩手综合征48例.河南中医,2001；21(3)：43.
[77]余恒旺,崔美莲,梁思杰,等.舒筋活络散治疗脑卒中后肩手征临床观察.中国中医急症,2006；15(9)：942.
[78]吴海科,顾卫,谭峰,等.舒筋洗药治疗脑卒中后肩手综合征42例.中医外治杂志,2004；13(6)：11.
[79]史玉香,孙建国,于智泉.脑卒中后肩手综合征早期疼痛中西医康复治疗的临床研究.泰山医学院学报,2006；27(3)：216-218.
[80]李庆生.中西医结合治疗急性脑血管病并发肩手综合征疗效观察.现代医药卫生,2003；19(12)：160.
[81]柴俊飞.推拿结合中药熏洗治疗卒中后肩手综合征临床体会.现代中西医结合杂志,2008；17(5)：722.
[82]刘运珠,张美花.针刺运动疗法治疗脑卒中并发肩手综合征60例.江苏中医药,2007；39(9)：54.
[83]张建国,徐悦泽.针灸结合康复治疗中风后肩手综合征80例.中国中医药科技,2008；15(2)：94.
[84]朱芬,陈尚杰,许琼瑜.康复训练与针刺有机组合对脑卒中肩手综合征FMA及BI的影响.中国康复,2009；24(3)：192.
[85]朱芬,陈尚杰,查思想.针刺配合康复训练对中风后肩手综合征疗效观察.上海针灸杂志,2009；28(5)：272-273.
[86]万裕萍,高宇飞.综合康复治疗脑卒中后肩手综合征的疗效观察.中华物理医学与康复杂志,2006；28(9)：647.
[87]陈鸣,针刺治疗脑卒中后肩-手综合症的临床观察.中国热带医学,2008；8(10)：1781.
[88]徐世芬,庄礼兴,贾超,等.靳三针疗法配合功能训练治疗中风偏瘫肩手综合征的临床观察.广州中医药大学学报,2010；27(1)：19-22.
[89]温静,张连城.调神通络法结合康复训练治疗卒中后肩手综合征30例临床观察.江苏中医药,2009；41(8)：55-56.
[90]刘远明.缪刺肩痛穴结合康复训练治疗肩手综合征的临床研究.甘肃医药,2009；28(3)：176-178.
[91]常娜,刘森.针灸结合康复训练治疗肩手综合征的疗效分析.第四军医大学学报, 2005；26(24)：2295-2297.
[92]史清钊,李春璐.电针对缓解肩手综合征腕部水肿与疼痛疗效的观察.航空航天医药,2007；18(1)：16-18.
[93]尚艳杰,马程程,蔡玉颖,等.针刺结合康复治疗中风后肩-手综合征.中国针灸,2008；28(5)：331-333.
[94]金瑛,汪军华,王爱君,等.针刺加康复训练治疗肩-手综合征40例疗效观察.针灸临床杂志,2007；23(1)：14-15.
[95]刘大建,张翔.针灸治疗反射性交感神经营养不良综合征的临床疗效.现代中西医结合杂志,2006；15(3)：326-327.
[96]唐强,张立雅,李晶.电针结合康复训练治疗脑卒中后肩-手综合征60例.针灸临床杂志,2005；21(4)：19-20.
[97]郭振强.针灸结合康复疗法治疗脑卒中后肩-手综合征40例.吉林中医药,2009；29(5)：416-417.
[98]中华神经学会.各类脑血管疾病诊断要点.中华神经科杂志,1996；29(6)：379-380.
[99]国家中医药管理局脑病急症科研协作组.中风病诊断和疗效评定标准.北京中医药大学学报,1996；(19)1：55.
[100]中华神经学会.脑卒中患者临床神经功能缺损程度评分标准(1995).中华神经科杂志,1996；29(6)：381-382.
[101]恽晓平.康复疗法评定学,北京：华夏出版社,2005：393-396.
[102]中华人民共和国卫生部医政司.中国康复医学诊疗规范(下册),北京：华夏出版社,1998：384.
[103]胡永善,吴毅,范文可,等.功能综合评定量表的研究(一)量表设计.中国康复医学杂志,2002；17(1)：35-38.
[104]王茂斌.偏瘫的现代评价与治疗,北京：华夏出版社,1990：226-231.
[105]陶子荣.我国脑卒中患者临床神经功能缺损评分标准信度、效度及敏感度的评价.第二军医大学学报,2009；30(3)：283-285.
[106]张通.脑卒中的功能障碍与康复.北京：科学技术文献出版社,2006：574.
[107]方军,胡永善.功能综合评定量表的信度与效度的初步研究.中华物理医学与康复杂志,2002；24(7)：424-425.
[108]范文可,胡永善,吴毅,等.功能综合评定量表效度的研究.中国康复医学杂志,2003；18(6)：325-329.
[109]朱镛连.脑卒中康复与神经康复机制.中国康复理论与实践,2003；9(3)：129-132.
[110]缪鸿石.中枢神经系统(CNS)损伤功能恢复的理论(一).中国康复理论与实 践,1995；1(1)：4.
[111]缪鸿石.中枢神经系统(CNS)损伤功能恢复的理论(八).中国康复理论与实践,1997；3(3)：103.
[112]Nelles G, Jentzen W, Jueptner M, et al. Arm training induced brain plasticity in stroke studied with serial positron emission tomography. Neuroimage,2001;13 (6 Pt 1):1146-1154.
[113]Levy CE, Nichols DS, Schmalbrock PM, et al. Functional MRI evidence of cortical reorganization in upper-limb stroke hemiplegia treated with constraint-induced movement therapy. Am J Phys Med Rehabil, 2001;80(1):4-11.
[114]倪朝民.脑卒中患者的肩部问题.现代康复,2000；4(4)：506-507.
[115]林文注.实验针灸学,上海：上海科学技术出版社,1994：44.
[116]彭力,李来支,彭锐,等.电针配合促通技术对急性脑卒中患者步行功能的影响.中国康复,2004；19(1)：26-27.
[117]石学敏.中风病与醒脑开窍针刺法,天津：天津科学出版社,2000：219-220.
[118]魏鹏绪.针刺治疗卒中后偏瘫的机理分析.中国康复理论与实践,2003；9(5)：300.
[119]木村研一.同时检测SSR和精神性出汗反应探讨针刺对皮肤交感神经功能的影响.国外医学·中医中药分册,1999；21(4)：38-39.
[120]Geertzen JH, Dijkstra PU, Groothoff JW, et al. Reflex sympathetic dystrophy of the upper extremity--a 5.5-year follow-up. Part Ⅰ. Impairments and perceived disability. Acta Orthop Scand Suppl,1998; 279:12-18.
[121]彭增福.靳三针疗法,上海：上海科学技术文献出版社,2000,第一版：16.
[122]李艳慧,靳瑞.三种不同针法治疗脑血管意外后遗症的研究.中国针灸,1993；13(4)：35-38.
[123]迪亚拉,靳瑞.“颞三针”治疗中风急性期的研究.针灸临床杂志,1995；11(8)：25-27.
[124]张雷,姚正业,纪春泓. “靳氏肩三针”与“传统肩三针”临床疗效比较后的体会.针灸临床杂志,1998；14(1)：1.
[125]卢佩斯,庄礼兴.中风偏瘫硬瘫期阴经刺法的应用.中华实用中西医杂志2005；18(22)：1643-1645.
[126]阮经文,罗仁翰.极泉穴合刺治疗中风后期肩关节活动功能障碍对照观察.广州中医学院学报,1995；12(1)：31-33.
[127]邢汝兰,朱富贵.按时针刺尺泽穴治疗脑梗死30例报告.中国临床康复,2002；6(7)：1036.
[128]楼新法,杨新东,戴开宇,等.尺泽穴断面桡神经定位及其意义.温州医学院学报,1998；28(1)：25-26.
[129]石学敏.以针灸治疗为中心的中风诊疗体系.江苏中医,1999；20(8)：3-4.
[130]石学敏.“醒脑开窍”针刺法治疗脑卒中.中国临床康复,2003；7(7)：1057-1058.
[131]庄捷,李天发.针刺结合运动疗法治疗中风后遗症78例.实徽中医临床杂志,2000；12(5)：385.
[132]殷汉贤,黄皖生,张德清,等.早期针刺推拿配合运动治疗中风偏瘫临床疗效分析.中国中西医结合急救杂志,2000；7(5)：302.
[133]史红斐.头体针结合运动疗法治疗脑卒中后遗症52例疗效观察.现代康复,2001；5(7)：118.
[134]闫喜莲,王文明,徐宝王.早期综合康复治疗急性脑卒中的疗效观察.中华物理医学与康复杂志,2004；23(10)：624.
[135]陈立典.偏瘫后肩手综合征的综合康复.中华理疗杂志,1997；20(1)：33.
[136]李响.112例中风偏瘫患者分组治疗的康复疗效分析.中国康复理论与实践,1997；3(1)：22-24.