针刺激痛点结合康复训练治疗缺血性中风后肩手综合征Ⅰ期临床研究

目的:在康复训练的基础上,观察针刺激痛点疗法与传统针刺疗法治疗缺血性中风后肩手综合征Ⅰ期的疗效差异,为缺血性中风后肩手综合征Ⅰ期的治疗提供参考。方法:60例缺血性中风后肩手综合征Ⅰ期患者随机分为针刺激痛点组和传统针刺组,每组30例。在患侧康复训练的基础上,针刺激痛点组采用0.35 mm×50 mm毫针,斜45°刺入并贯穿激痛点结节,提插至出现针感后留针30 min,传统针刺组选取肩髃、肩髎、肩贞等,应用0.35 mm×50 mm毫针直刺,提插捻转至出现针感后留针30 min。每天治疗1次,每周治疗5天,休息2天,连续3周。两组在治疗15天后,采用国际公认的简化麦吉尔疼痛量表(McGill)、肩手综合征评估量表(SHSS)和简化Fugl-Meyer运动功能量表(FMA)作为观察指标,以患者治疗前后上肢的疼痛症状、损伤程度、运动功能指数的变化来评价疗效。结果:激痛点针刺组愈显率30%(9/30),优于传统针刺组愈显率13.3%(4/30)(P<0.01),治疗后两组McGill、SHSS、FMA评分较治疗前有显著改善(均P<0.01);且针刺激痛点组的改善程度均优于传统针刺组(均P<0.05)。结论:针刺激痛点结合康复训练对缺血性中风后肩手综合征Ⅰ期具有良好的治疗效果,优于传统针刺结合康复训练。

Effect Observation on Needling Trigger Points Combined with Rehabilitation Training in Treating Post-Stroke SHS of Phase I

Objective:To compare the difference of needling trigger points and conventional acupuncture in treating phase I should-hand syndrome(SHS)after ischemic stroke on the basis of rehabilitation training,so as to provide the reference for treating this kind of disease effectively.Methods:60 patients met the inclusion criteria were randomly divided into the observation group(n=30)and the control group(n=30).The control group was treated with conventional acupuncture combined with rehabilitation training;whereas the observation group was treated with needling trigger points combined with rehabilitation.The needles used in the two groups were filiform needles of 0.35 mm×50 mm,and the needle retention for each group was 30 min.The points chosen in the observation group were myofascial trigger points with oblique angle of 45 degree insertion.The points chosen for the needling were Jianyu(LI15),Jianliao(TE14)and Jianzhen(SI9)in the control group.The treatment was once a day,5 days per week,for a total of three weeks.The scores of simple McGill pain scale(McGill),the shoulder hand syndrome scale(SHSS)and the modified Fugl-Meyer motor function scale(FMA)were observed after 15 days of treatment.The changes of the upper limb pain,the damage severity and the motor function were evaluated to assess the clinical efficacy.Results:The markedly effective rate of the observation group was 30%(9/30),which was significantly higher than 13.3%(4/30)of the control group(P<0.01).The scores of simple McGill,SHSS and modified FMA were greatly improved in the two groups after the treatment(P<0.01),and the improvements in the observation group were more significant(P<0.05).Conclusion:Needling trigger points combined with rehabilitation training has a good therapeutic effect on post-stroke SHS of phase I,and the therapy is superior to conventional acupuncture combined with rehabilitation training.