【摘要】：目的:觀察電針聯(lián)合康復(fù)治療對中風(fēng)后肩關(guān)節(jié)半脫位的臨床療效,為臨床尋找一種操作簡便、安全有效的治療中風(fēng)后肩關(guān)節(jié)半脫位的方法。方法:將60例中風(fēng)后符合本研究納入標(biāo)準(zhǔn)的肩關(guān)節(jié)半脫位患者隨機(jī)分為奇穴組、常規(guī)針刺組、康復(fù)對照組,每組各20例,以上三組患者均采取相同的基礎(chǔ)治療,而奇穴組和常規(guī)針刺組都運(yùn)用電針刺激聯(lián)合康復(fù)治療,奇穴組針刺選取岡上肌和三角肌上的穴位,常規(guī)針刺組選取三角肌上的穴位;康復(fù)對照組運(yùn)用純康復(fù)療法,三組療程均為4周。治療前及療程結(jié)束后均對比三組患者患側(cè)肩部疼痛評分(VAS)、肩峰下緣與肱骨頭間的最小距離(AHI)、上肢運(yùn)動功能(FMA)的變化情況,并進(jìn)行綜合統(tǒng)計(jì)分析。結(jié)果:1.治療后三組患者在肩痛方面均有不同程度的緩解,治療前后差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01),其中肩痛緩解的程度奇穴組比康復(fù)對照組明顯,差異顯著(P0.01),而奇穴組與常規(guī)針刺組比較、常規(guī)針刺組與康復(fù)對照組比較疼痛均有緩解,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。2.治療后三組患者肩關(guān)節(jié)半脫位的距離均有不同程度的縮小,治療前后差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01),其中距離縮小的程度奇穴組較康復(fù)對照組明顯,差異顯著(P0.01),而奇穴組與常規(guī)針刺組比較、常規(guī)針刺組與康復(fù)對照組比較半脫位距離均有縮小,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。3.療程結(jié)束后三組患者在上肢運(yùn)動功能方面的改善評分均有明顯提高,治療前后差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01),其中功能改善奇穴組較康復(fù)對照組明顯,差異顯著(P0.01),而奇穴組與常規(guī)針刺組比較、常規(guī)針刺組與康復(fù)對照組比較功能改善均較明顯,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。4.療程結(jié)束后經(jīng)Ridit分析三組患者的綜合療效,R奇穴R常規(guī)針剌R康復(fù),即綜合療效奇穴組優(yōu)于常規(guī)針刺組,而常規(guī)針刺組優(yōu)于康復(fù)對照組。結(jié)論:1.電針聯(lián)合康復(fù)治療與單純康復(fù)治療對中風(fēng)后肩關(guān)節(jié)半脫位癥狀均有改善作用,但電針聯(lián)合康復(fù)治療優(yōu)于單純康復(fù)治療。2.電針刺激岡上肌和三角肌上的穴位,在很大程度上緩解了患側(cè)肩部疼痛、減小半脫位距離、促進(jìn)患側(cè)上肢運(yùn)動功能的恢復(fù),其治療效果比單純電針刺激三角肌上的穴位更優(yōu)。
[Abstract]:Objective: to observe the clinical effect of electroacupuncture combined rehabilitation therapy on shoulder subluxation after stroke and to find a safe and effective method for treating shoulder subluxation after stroke. Methods: sixty patients with subluxation of shoulder joint were randomly divided into three groups: Qi-point group, routine acupuncture group and rehabilitation control group, 20 cases in each group. The patients in the above three groups were treated with the same basic therapy. The Qi-point group and the conventional acupuncture group were treated with electroacupuncture combined rehabilitation therapy. The Qi-point group selected the points on the supraspinatus muscle and the deltoid muscle, the conventional acupuncture group selected the points on the deltoid muscle, and the rehabilitation control group used pure rehabilitation therapy. All the three groups were treated for 4 weeks. The changes of shoulder pain score (VAS), the minimum distance between the lower margin of acromion and humerus head (AHI) and the motor function of upper limb (FMA) were compared before and after treatment. The result is 1: 1. After treatment, the three groups had different degree of relief in shoulder pain, and the difference was statistically significant before and after treatment (P0.01). The degree of relief of shoulder pain in Qipoint group was significantly higher than that in rehabilitation control group (P0.01), and the Qi-point group was significantly different from that of routine acupuncture group (P0.01). Routine acupuncture group and rehabilitation control group compared with the pain relief, the differences were statistically significant (P0.05). 2. After treatment, the distance of shoulder subluxation in the three groups was reduced to different degrees, and the difference before and after treatment was statistically significant (P0.01). The difference was significant (P0.01). Compared with the routine acupuncture group, the distance of subluxation between the routine acupuncture group and the rehabilitation control group was reduced, and the difference was statistically significant (P0.05). 3. At the end of the treatment, the improvement scores of upper limb motor function in the three groups were obviously improved, and the difference before and after treatment was statistically significant (P0.01), among which the improvement of function at Qi-point group was more obvious than that in the rehabilitation control group. The difference was significant (P0.01), and Qi-point group and routine acupuncture group, routine acupuncture group and rehabilitation control group compared with the functional improvement was more significant (P0.05). 4. After the course of treatment, Ridit was used to analyze the comprehensive curative effect of the three groups, namely, the comprehensive curative effect was superior to the routine acupuncture group, and the routine acupuncture group was superior to the rehabilitation control group. Conclusion 1. Both electroacupuncture combined rehabilitation therapy and simple rehabilitation therapy can improve the symptoms of shoulder subluxation after stroke, but electroacupuncture combined rehabilitation therapy is better than simple rehabilitation treatment. Electroacupuncture stimulation of supraspinatus muscle and deltoid point greatly alleviated shoulder pain, reduced the distance of subluxation, and promoted the recovery of motor function of the affected upper limb. The therapeutic effect was better than that of electroacupuncture alone in stimulating acupoints on deltoid muscle.
【學(xué)位授予單位】：黑龍江中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R246.6

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