针刀联合针刺治疗脑卒中痉挛性瘫痪的临床观察

A Clinical Observation on Acupotomy Combined with Acupuncture in the Treatment of Spastic Paralysis after Stroke

摘要: 目的：评估针刀联合针刺疗法治疗脑卒中痉挛性瘫痪的临床疗效。方法：选取160例脑卒中痉挛性瘫痪患者，依据随机数字法分为4组：常规康复组(对照组)、针刀康复组(治疗1组)、针刺康复组(治疗2组)以及针刀联合针刺康复组(治疗3组)，每组各40例。所有组别均接受常规康复治疗，每日1次，每周5次，共4周。在此基础上，治疗1组加用针刀治疗(每周2次)，治疗2组加用针刺治疗(每日1次)，治疗3组则联合应用针刀与针刺治疗。在治疗前与治疗4周后，采用改良Ashworth痉挛量表(MAS)、简化Fugl-Meyer运动功能评定量表(FMA)以及改良Barthel指数(MBI)来分别评估患者的肌张力状况、下肢运动功能及日常生活活动能力。结果：治疗4周后，四组患者的MAS评分均较治疗前显著降低，FMA与MBI评分均较治疗前显著升高(P < 0.05)。组间比较显示，治疗3组在MAS、FMA及MBI评分的改善幅度上均显著优于其他三组(P < 0.05)。结论：针刀联合针刺疗法能有效降低脑卒中痉挛性瘫痪患者的肌张力，显著改善其运动功能和日常生活活动能力，其综合疗效优于单一疗法或单纯康复治疗。

Abstract: Objective: To evaluate the clinical efficacy of acupotomy combined with acupuncture in the treatment of spastic paralysis after stroke. Methods: A total of 160 patients with post-stroke spastic paralysis were selected and randomly divided into four groups: the conventional rehabilitation group (control group), the acupotomy rehabilitation group (treatment group 1), the acupuncture rehabilitation group (treatment group 2), and the acupotomy combined with acupuncture rehabilitation group (treatment group 3), with 40 patients in each group. All groups received conventional rehabilitation therapy once daily, five times per week, for a total of 4 weeks. On this basis, treatment group 1 received additional acupotomy treatment (twice a week), treatment group 2 received additional acupuncture treatment (once daily), and treatment group 3 received a combination of acupotomy and acupuncture. The Modified Ashworth Scale (MAS), the simplified Fugl-Meyer Assessment (FMA)for lower extremities, and the Modified Barthel Index (MBI) were used to assess muscle tone, lower limb motor function, and activities of daily living (ADL), respectively, before and after the 4-week treatment period. Results: After 4 weeks of treatment, MAS scores in all four groups were significantly decreased, while FMA and MBI scores were significantly increased compared to before treatment (P < 0.05). Intergroup comparison showed that the degree of improvement in MAS, FMA, and MBI scores in treatment group 3 was significantly superior to that in the other three groups (P < 0.05). Conclusion: The combination of acupotomy and acupuncture can effectively reduce muscle tone, significantly improve motor function and ADL in patients with spastic paralysis after stroke, demonstrating superior comprehensive efficacy compared to monotherapy or rehabilitation alone.