枢经理论指导下冲击波联合中药烫熨治疗脑卒中肩手综合征的临床研究

Clinical Study of Extracorporeal Shock Wave Combined with Traditional Chinese Medicine Hot Ironing Therapy Guided by Shu Meridian Theory in the Treatment of Post-Stroke Shoulder-Hand Syndrome

摘要: 目的：观察枢经理论指导下冲击波联合中药烫熨治疗脑卒中肩手综合征(SHS)的临床疗效，为临床优化治疗方案提供循证依据。方法：选取2024年9月~2025年9月本院康复医学科收治的120例脑卒中肩手综合征患者为研究对象，经本院医学伦理委员会批准后，采用随机数字表法分为冲击波组、中药烫熨组、联合组，每组40例。三组均予脑卒中基础治疗及常规康复训练，冲击波组加用单纯冲击波治疗，中药烫熨组加用单纯中药烫熨治疗，联合组加用枢经理论指导下冲击波联合中药烫熨治疗，均连续治疗2周。建立系统性不良事件监测与记录方案，全程评估治疗安全性；比较三组治疗前后疼痛视觉模拟评分(VAS)、Fugl-Meyer上肢运动功能评分(FMA)、改良Barthel指数(MBI)，并评价三组临床疗效。结果：治疗前，三组患者VAS、FMA、MBI评分比较，差异均无统计学意义(P > 0.05)；治疗2周后，三组患者VAS评分均较治疗前显著降低，FMA、MBI评分均较治疗前显著升高，差异均有统计学意义(P < 0.05)；且联合组VAS评分低于冲击波组、中药烫熨组，FMA、MBI评分高于冲击波组、中药烫熨组，差异均有统计学意义(P < 0.05)。联合组总有效率为95.00%，高于冲击波组的77.50%、中药烫熨组的80.00%，差异均有统计学意义(P < 0.05)。结论：枢经理论指导下冲击波联合中药烫熨治疗脑卒中肩手综合征，可有效缓解患者患肢疼痛，显著改善上肢运动功能及日常生活活动能力，且安全性高，不良反应轻微且可控，临床疗效确切，优于单一冲击波或中药烫熨治疗，值得临床推广应用。

Abstract: Objective: To observe the clinical efficacy of extracorporeal shock wave combined with traditional Chinese medicine (TCM) hot ironing therapy guided by Shu Meridian Theory in the treatment of post-stroke shoulder-hand syndrome (SHS), so as to provide evidence-based basis for clinical optimization of treatment regimens. Methods: A total of 120 patients with post-stroke shoulder-hand syndrome admitted to the Department of Rehabilitation Medicine of our hospital from September 2024 to September 2025 were selected as research subjects. After approval by the Medical Ethics Committee of our hospital, they were divided into shock wave group, TCM hot ironing group and combined treatment group by random number table method, with 40 cases in each group. All three groups received basic stroke treatment and routine rehabilitation training. The shock wave group was additionally treated with extracorporeal shock wave alone, the TCM hot ironing group with TCM hot ironing alone, and the combined treatment group with extracorporeal shock wave combined with TCM hot ironing therapy guided by Shu Meridian Theory. All treatments lasted for 2 consecutive weeks. A systematic adverse event monitoring and recording scheme was established to evaluate the treatment safety throughout the course. The Visual Analogue Scale (VAS) score, Fugl-Meyer Assessment (FMA) score of upper limb motor function, and Modified Barthel Index (MBI) were compared among the three groups before and after treatment, and the clinical efficacy was evaluated. Results: Before treatment, there were no statistically significant differences in VAS, FMA and MBI scores among the three groups (P > 0.05). After 2 weeks of treatment, the VAS scores of the three groups were significantly decreased, while the FMA and MBI scores were significantly increased compared with those before treatment (P < 0.05). Moreover, the VAS score of the combined treatment group was lower than those of the shock wave group and the TCM hot ironing group, and the FMA and MBI scores were higher than those of the other two groups (P < 0.05). The total effective rate of the combined treatment group was 95.00%, which was higher than 77.50% in the shock wave group and 80.00% in the TCM hot ironing group (P < 0.05). Conclusion: Extracorporeal shock wave combined with TCM hot ironing therapy guided by Shu Meridian Theory can effectively relieve limb pain, significantly improve upper limb motor function and activities of daily living in patients with post-stroke shoulder-hand syndrome, with high safety and mild, controllable adverse reactions. It has definite clinical efficacy and high safety, which is superior to single shock wave or TCM hot ironing therapy, and is worthy of clinical promotion and application.