浮针灌注疗法联合关节松动术对脑卒中偏瘫肩痛的影响

目的:观察浮针灌注疗法联合关节松动术对脑卒中偏瘫肩痛的影响。方法:选取2019年2—12月在山东省立第三医院康复医学科住院治疗的脑卒中偏瘫肩痛患者90例,按随机数字表法分为对照组、浮针组和综合组,每组30例。对照组仅给予常规康复训练,包括良肢位摆放、预防二次损伤、主动或助动的功能锻炼、低频电刺激、上肢日常生活活动能力模拟训练等,25 min/次,1次/d,5次/周,持续治疗4周。浮针组在对照组基础上给予浮针灌注治疗,肩关节前部疼痛明显时,患肌一般在肘关节远心端5 cm处,肩关节中间或后侧疼痛明显时,患肌一般在三角肌后下缘附近;以患肌作为进针点,针尖朝向肩关节,针体刺入疏松结缔组织后进行弧形扫散,频率100次/min,每组扫散1 min,每次做3组;每组扫散后要求患者主动或助动活动肩关节10次,活动方向和范围以引起轻度疼痛为佳,留针24 h,2次/周,持续治疗4周。综合组在浮针组基础上给予肩关节松动治疗,25 min/次,1次/d,5次/周,肩关节松动治疗先以1~2级手法改善肩关节疼痛,再以3~4级手法松解粘连,包括沿长轴分离和牵拉肩关节以缓解疼痛,滑动以松解关节囊,摆动以维持和扩大关节活动度,采取达到而不超过痛点的原则,每种手法重复3~4次。于治疗前、治疗4周后,分别采用疼痛视觉模拟评分(VAS)评定肩关节疼痛程度,采用Fugl-Meyer运动功能评分量表(FMA)评定上肢运动功能,采用改良Barthel指数(MBI)评定日常生活活动能力,采用量角器测量患者肩关节被动关节活动度(PROM)。结果:治疗前,3组VAS评分、FMA评分、MBI评分和肩关节PROM比较,差异无统计学意义(P>0.05)。与治疗前比较,3组治疗4周后VAS评分明显降低,FMA评分、MBI评分和肩关节PROM均明显升高,差异均有统计学意义(P<0.05)。与对照组比较,浮针组和综合组的VAS评分明显降低,FMA评分、MBI评分和肩关节PROM均明显升高,差异均有统计学意义(P<0.05)。与浮针组比较,综合组VAS评分明显更低,FMA、MBI评分和肩关节PROM均明显更高,差异均有统计学意义(P<0.05)。结论:浮针灌注疗法联合关节松动术能有效减轻脑卒中后偏瘫肩痛,改善上肢运动功能和日常生活活动能力,值得临床推广。

Effect of Floating Needle Perfusion Therapy combined with Joint Mobilization on Shoulder Pain of Hemiplegia after Stroke

Objective:To observe the effect of floating needle perfusion therapy combined with joint mobilization on shoulder pain of hemiplegia after stroke.Methods:A total of 90 hemiplegia patients with shoulder pain after stroke in the department of rehabilitation medicine of Shandong Provincial Third Hospital from February to December 2019,which were divided into the control group,the floating needle group and the comprehensive group according to the random number table,with 30 cases in each group.The control group only received routine rehabilitation training,including normal limb position,prevention of secondary injury,active or auxiliary functional exercise,low-frequency electrical stimulation,and daily living ability simulation training of upper limb,etc.,25 minutes a time,once a day,five days per week,continuous treatment for four weeks.The floating needle group received floating needle perfusion therapy on the basis of the control group,when the pain in the front of the shoulder joint was obvious,the affected muscle was generally 5 cm from the distal end of the elbow joint,when the pain in the middle or back of the shoulder joint was obvious,the affected muscle was generally near the posterior lower edge of the deltoid muscle.The affected muscle was taked as the needle entry point,and the needle tip was facing the shoulder joint,after inserting into the loose connective tissue,the needle body was scanned in arc,100 times per min,one min per group,three groups each time.After each sweep,the shoulder joint should be actively or assist to move around 10 times,the direction and range of motion should be mild pain,keeping the needle for 24 h,twice a week,continuous treatment for four weeks.The comprehensive group received shoulder joint mobilization treatment on the basis of the floating needle group,25 min per time,once a day,five days per week.Firstly,the pain of shoulder joint was relieved by 1-2 grade manipulation,and then the adhesion was released by 3-4 grade manipulation,including separating and pulling shoulder joint along the long axis to relieve pain,sliding to release joint capsule,swinging to maintain and expand joint range of motion,taking measures to reach but not exceed the pain point,each manipulation was performed 3-4 times.Before treatment and after treatment for four weeks,the visual analogue scale(VAS)was used to assess shoulder pain,the Fugl-Meyer assessment(FMA)was used to assess upper extremity motor function,the modified Barthel index(MBI)was used to assess activities of daily living,and the goniometer was used to measure the passive range of motion of the shoulder joint.Results:Before treatment,there were no significant differences in VAS scores,FMA scores,MBI scores and PROM of the shoulder joint in three groups,with no statistically significant differences(P>0.05).Compared with before treatment,the VAS score of the three groups after treatment for four weeks decreased significantly,while the FMA score,MBI score and PROM of the shoulder joint increased significantly,with statistically significant differences(P<0.05).Compared with the control group,the VAS scores of the floating needle group and the comprehensive group decreased significantly,while the the FMA score,MBI score and PROM of the shoulder joint increased significantly,with statistically significant differences(P<0.05).Compared with the floating needle group,the VAS score of the comprehensive group decreased significantly,while the FMA,MBI scores and PROM of the shoulder joint increased significantly,with statistically significant differences(P<0.05).Conclusion:Floating needle perfusion therapy combined with joint mobilization could effectively relieve shoulder pain of hemiplegia patients after stroke,and improve the motor function of upper limb and activity of daily living,which is worthy of clinical application and promotion.