电针配合康复训练治疗脑卒中后肩手综合征的临床研究
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摘要
目的:通过观察电针配合康复训练对脑卒中后肩手综合征患者上肢运动功能、疼痛及水肿、肩关节及掌指关节活动度、日常生活活动能力的影响,探讨电针结合康复训练对脑卒中后肩手综合征的治疗作用。
方法:选取脑卒中后肩手综合征患者92例,随机分为电针组30例,康复组31例,电针结合康复组31例。三组均每周治疗6次,共治疗4周为1疗程。电针组每天给予电针治疗一次、康复组每天给予康复训练一次,电针结合康复组每天给予电针与康复训练各一次。治疗前及1疗程结束后进行相关临床功能评定:上肢运动功能评定采用上肢简化Fugl-Meyer评分(FMA)、上肢疼痛、水肿评定采用视觉模拟量表(VAS)、肩关节活动度采用关节量角器测量、掌指关节活动度以拇指尖与手掌的距离记分、日常生活活动能力ADL采用改良的Barthel指数(MBI),并进行统计学处理分析;疗程结束后进行肩手综合征综合疗效评定及各期疗效比较。
结果:电针配合康复组治疗脑卒中后肩手综合征总有效率为93.55%,电针组总有效率为83.33%,康复组总有效率为67.74%。在治疗总有效率,各期疗效比较、改善上肢运动功能、疼痛、肿胀的程度,肩、掌指关节活动度上,电针配合康复组均优于电针组和康复组,有非常显著性差异(P﹤0.01)和显著性差异(P﹤0.05)。在肩部疼痛、手肿胀的改善方面,电针优于康复组(P﹤0.01)。日常生活活动能力的改善,三组比较无显著性差异(P﹥0.05)。
结论:电针配合康复训练对脑卒中后肩手综合征有明显镇痛、消肿、改善关节活动度的作用,能缓解痉挛,改善上肢运动功能,增加肩、掌指关节活动度,以促使脑卒中后功能的恢复。其治疗脑卒中后肩手综合征的疗效,优于单纯电针与单纯康复训练疗法。
Objective : Through clinical research, systematic observation effect of electroacupuncture combined with rehabilitation training on upper limb motor function,paining degree,palm swelling level,shoulder joint and metacarpophal angeal joint from mobility, activities of daily living in the patients with shoulder-hand syndrome of post-stroke. To study the therapeutic effects of electroacupuncture combined with rehabilitation training on shoulder hand syndrome of post-stroke.Method:Screening of clinical shoulder-hand syndrome of post-stroke 92 patients, 30 cases were randomly divided into electroacupuncture group, rehabilitation training group 31 cases of 31 patients with the electroacupuncture combined with rehabilitation training group. Three groups of patients were six times a week, four weeks of treatment for 1 of treatment. Patients in the electroacupuncture group were treated only with electroacupuncture, patients in the rehabilitation training group were treated only with rehabilitation training, and the patients in electroacupuncture combined with rehabilitation training group were treated with both acupuncture and rehabilitation training. The three groups were evaluated before treatment and after the whole treatment course. Upper 1imb motor function was evaluated by Simplified Fugl-Meyer Assessment(FMA),pain degree and palm swelling level was evaluated by VisualAnalogueSeale(VAS),Shoulder joint activity was measured by protractor, metacarpophalangeal joint from mobility was scored by thumb pointed with palm at a distance,activity of daily Iiving was evaluated by. improved Barthel index (MBI) . The comprehensive effect was evaluated after the treatment course. Result: The total effective rate is 93.55% in the electroacupuncture combined with rehabilitation group , 83.33 % in the electroacupuncture group and 67.74%in the rehabilitation group.Using electroacupuncture combined with rehabilitation training on total effective rate, upper limb motor function ,paining degree ,palm swelling level,shoulder joint and metacarpophalangeal joint from mobility is superior to electroacupuncture group and rehabilitation group, has a very significant difference (P<0.01). And in the improvement of shoulder pain and palm swelling level,the electroacupuncture group is better than rehabilitation group (P<0.01). Activities of daily living of the improved, three groups compared the non-significance difference (P>0.05). Conclusions: The E1ectroacupuncture and rehabilitation can relieve pain and swelling effectually on treating Shou1der-hand Syndrome of post-stroke.This method was able to improve range of motion effect, can alleviate cramps, increase in upper limb motor function, shoulder, finger joint activity to promote post-stroke function recovery.The electroacupuncture combined with rehabilitation is superior to electroacupuncture group and rehabilitation group。
方法:选取脑卒中后肩手综合征患者92例,随机分为电针组30例,康复组31例,电针结合康复组31例。三组均每周治疗6次,共治疗4周为1疗程。电针组每天给予电针治疗一次、康复组每天给予康复训练一次,电针结合康复组每天给予电针与康复训练各一次。治疗前及1疗程结束后进行相关临床功能评定:上肢运动功能评定采用上肢简化Fugl-Meyer评分(FMA)、上肢疼痛、水肿评定采用视觉模拟量表(VAS)、肩关节活动度采用关节量角器测量、掌指关节活动度以拇指尖与手掌的距离记分、日常生活活动能力ADL采用改良的Barthel指数(MBI),并进行统计学处理分析;疗程结束后进行肩手综合征综合疗效评定及各期疗效比较。
结果:电针配合康复组治疗脑卒中后肩手综合征总有效率为93.55%,电针组总有效率为83.33%,康复组总有效率为67.74%。在治疗总有效率,各期疗效比较、改善上肢运动功能、疼痛、肿胀的程度,肩、掌指关节活动度上,电针配合康复组均优于电针组和康复组,有非常显著性差异(P﹤0.01)和显著性差异(P﹤0.05)。在肩部疼痛、手肿胀的改善方面,电针优于康复组(P﹤0.01)。日常生活活动能力的改善,三组比较无显著性差异(P﹥0.05)。
结论:电针配合康复训练对脑卒中后肩手综合征有明显镇痛、消肿、改善关节活动度的作用,能缓解痉挛,改善上肢运动功能,增加肩、掌指关节活动度,以促使脑卒中后功能的恢复。其治疗脑卒中后肩手综合征的疗效,优于单纯电针与单纯康复训练疗法。
Objective : Through clinical research, systematic observation effect of electroacupuncture combined with rehabilitation training on upper limb motor function,paining degree,palm swelling level,shoulder joint and metacarpophal angeal joint from mobility, activities of daily living in the patients with shoulder-hand syndrome of post-stroke. To study the therapeutic effects of electroacupuncture combined with rehabilitation training on shoulder hand syndrome of post-stroke.Method:Screening of clinical shoulder-hand syndrome of post-stroke 92 patients, 30 cases were randomly divided into electroacupuncture group, rehabilitation training group 31 cases of 31 patients with the electroacupuncture combined with rehabilitation training group. Three groups of patients were six times a week, four weeks of treatment for 1 of treatment. Patients in the electroacupuncture group were treated only with electroacupuncture, patients in the rehabilitation training group were treated only with rehabilitation training, and the patients in electroacupuncture combined with rehabilitation training group were treated with both acupuncture and rehabilitation training. The three groups were evaluated before treatment and after the whole treatment course. Upper 1imb motor function was evaluated by Simplified Fugl-Meyer Assessment(FMA),pain degree and palm swelling level was evaluated by VisualAnalogueSeale(VAS),Shoulder joint activity was measured by protractor, metacarpophalangeal joint from mobility was scored by thumb pointed with palm at a distance,activity of daily Iiving was evaluated by. improved Barthel index (MBI) . The comprehensive effect was evaluated after the treatment course. Result: The total effective rate is 93.55% in the electroacupuncture combined with rehabilitation group , 83.33 % in the electroacupuncture group and 67.74%in the rehabilitation group.Using electroacupuncture combined with rehabilitation training on total effective rate, upper limb motor function ,paining degree ,palm swelling level,shoulder joint and metacarpophalangeal joint from mobility is superior to electroacupuncture group and rehabilitation group, has a very significant difference (P<0.01). And in the improvement of shoulder pain and palm swelling level,the electroacupuncture group is better than rehabilitation group (P<0.01). Activities of daily living of the improved, three groups compared the non-significance difference (P>0.05). Conclusions: The E1ectroacupuncture and rehabilitation can relieve pain and swelling effectually on treating Shou1der-hand Syndrome of post-stroke.This method was able to improve range of motion effect, can alleviate cramps, increase in upper limb motor function, shoulder, finger joint activity to promote post-stroke function recovery.The electroacupuncture combined with rehabilitation is superior to electroacupuncture group and rehabilitation group。
引文
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