浮针治疗卒中后痉挛的临床应用及潜在作用机制研究进展

Research Progress on the Clinical Application and Potential Mechanisms of Fu’s Subcutaneous Needling for Post-Stroke Spasticity

摘要: 卒中后痉挛(post-stroke spasticity, PSS)是脑卒中后常见的运动功能障碍，主要表现为异常肌肉过度活动、肌张力增高及运动模式异常，并可继发疼痛、关节活动受限、挛缩及日常生活活动能力下降。现代康复、口服抗痉挛药物及肉毒毒素注射等是目前常用的干预手段，但仍存在适应证限制、疗效个体差异及不良反应等问题。浮针疗法以皮下浅层操作、患肌辨识、扫散及再灌注活动(reperfusion approach, RA)为主要技术特点，近年来逐渐应用于PSS。现有临床研究及Meta分析提示，浮针单独应用或联合RA、康复训练可能改善痉挛相关临床表现、运动功能及日常生活活动能力，但受研究质量、干预异质性及长期随访不足等限制，目前尚不足以明确其独立效应、相对疗效及可能获益的患者特征。现有研究提示，浮针的潜在作用可能涉及外周组织、神经肌肉及感觉运动调控等多个层级，但尚未形成连续、直接的机制证据链；普通针刺动物实验所提示的KCC2-GABAA相关抑制性调节仅可作为间接机制线索，不能视为浮针治疗PSS的特异性机制。本文围绕PSS的病理基础、浮针技术特点、临床应用、潜在作用机制及现有研究局限进行综述，并与干针、银质针、经皮神经电刺激及体外冲击波等非药物干预技术进行比较，以期为浮针治疗PSS的规范化临床应用及后续高质量研究提供参考。

Abstract: Post-stroke spasticity (PSS) is a common motor disorder after stroke, characterized mainly by involuntary muscle overactivity, increased muscle tone, and abnormal motor patterns, and may lead to pain, restricted range of motion, contracture, and reduced activities of daily living. Conventional rehabilitation, oral antispastic agents, and botulinum toxin injections are commonly used interventions, but limitations remain regarding indications, individual treatment responses, and adverse effects. Fu’s subcutaneous needling (FSN) is characterized by superficial subcutaneous manipulation, identification of tightened muscles, swaying manipulation, and the reperfusion approach (RA), and has increasingly been applied to PSS. Available clinical studies and meta-analyses suggest that FSN, alone or combined with RA and rehabilitation training, may improve spasticity-related clinical manifestations, motor function, and activities of daily living. However, limitations in methodological quality, intervention heterogeneity, and long-term follow-up preclude firm conclusions regarding its independent effects, relative efficacy, and patient characteristics associated with potential benefit. Current evidence suggests that the potential effects of FSN may involve peripheral tissue, neuromuscular, and sensorimotor regulatory processes, but a continuous and direct mechanistic evidence chain has not yet been established. KCC2-GABAA-related inhibitory regulation identified in animal studies of conventional acupuncture should be regarded only as an indirect mechanistic clue rather than an FSN-specific mechanism for PSS. This review summarizes the pathophysiological basis of PSS, technical characteristics and clinical applications of FSN, potential mechanisms, and limitations of existing research, and compares FSN with dry needling, silver needle therapy, transcutaneous electrical nerve stimulation, and extracorporeal shock wave therapy as non-pharmacological interventions, to inform standardized clinical application and future high-quality research.