摘要
目的:评价"针推双通治疗方案"治疗偏瘫肩痛的临床疗效。方法:采用双中心随机对照临床试验研究方法,将符合脑卒中后肩痛的300例患者随机分为针推组和康复组。针推组给予规范化的电针与推拿治疗,即电针尺泽、曲泽、少海、肩髃、肩髎、肩井等主穴并配合传统按摩手法操作;康复组给予经皮神经电刺激结合PNF挤压稳定手法等康复方案治疗。两组疗程均为6周。主要疗效指标为肩部被动活动时疼痛面谱量化评级(AFS)和Fugl-Meyer上肢功能活动评定,次要疗效指标为改良Rankin修订量表(mRS)和治疗后偏瘫肩手综合征与偏瘫肩关节半脱位临床发生率。结果:针推组治疗后及随访12周,AFS评分、Fugl-Meyer上肢功能活动评定及mRS评定均较康复组改善明显(P<0.05,P<0.01)。尽管治疗后针推组偏瘫肩手综合征与偏瘫肩关节半脱位临床发生率与康复组治疗相当[3.55%(5/141)vs 8.45%(12/142),1.42%(2/141)vs 5.63%(8/142),均P>0.05],但数据提示针推组有优于康复组趋势。结论:针推双通治疗方案操作规范,治疗中风后肩痛有较好的疗效,且疗效优于康复综合方案。
Objective To evaluate clinical therapeutic effect of post-stroke shoulder pain treated by acupuncture combined with Tuina.Methods Three hundred cases of post-stroke shoulder pain were randomly divided into an acupuncture and Tuina group and a rehabilitation group by double-center randomized controlled clinical trial method.In acupuncture and Tuina group,normalized electroacupuncture and Tuina therapy were applied,that was electroacupuncture at main points,such as Chize（LU 5）,Quze（PC 3）,Shaohai（HT 3）,Jianyu（LI 15）,Jianliao（TE 14） and Jianjing（GB 21）,etc.,combined with traditional Tuina manipulations;in rehabilitation group,the rehabilitation methods such as the electrostimulation through nervus cutaneus and the squeezing and stabilizing manipulations of Proprioceptive Neuromuscular Facilitation（PNF）,etc.were applied.The treatment courses of both groups were 6 weeks.The main therapeutic effect indices were the Assessment Face Scale（AFS） for pain when shoulder was in passive motion and the Fugl-Meyer Motor Assessment for upper limbs active function;the secondary indices were the moditied Rankin Scale（mRS） and the clinical incidences of shoulder-hand syndrome of hemiplegia and shoulder joint subluxation of hemiplegia.Results After 6 weeks treatment and 12 weeks follow-up,AFS score,Fugl-Meyer motor assessment of upper limbs active function and mRS evaluation in acupuncture and Tuina group were more obviously improved than those in rehabilitation group（P0.05,P0.01）.Although the clinical incidences of shoulder-hand syndrome of hemiplegia and shoulder joint subluxation of hemiplegia in acupuncture and Tuina group was equal to those in rehabilitation group [3.55%（5/141） vs 8.45%（12/142）,1.42%（2/141） vs 5.63%（8/142）,both P0.05],the data indicated that there was a superiority tendency in acupuncture and Tuina group.Conclusion The combined therapy of electroacupuncture and Tuina is a normative manipulation,and the therapeutic effect is satisfying for post-stroke shoulder pain,superior to that of comprehensive rehabilitation treatment.
出处
《中国针灸》
CAS
CSCD
北大核心
2012年第2期101-105,共5页
Chinese Acupuncture & Moxibustion
基金
四川省中医药管理局临床科研立项项目:2010SZ 0084
关键词
脑卒中
偏瘫
肩痛
电针
推拿
随机对照试验
Stroke
Hemiplegia
Shoulder Pain
Electroacupuncture
Massage
Randomized Controlled Trial（RCT）
