超声引导下针刀治疗卒中后肩痛的随机对照研究Randomized Controlled Trial on Post-stroke Shoulder Pain with Ultrasound-guided Acupotomy
庄璇,陈德钦,许梅娜,王永,金海鹏,黄源鹏
摘要(Abstract):
目的 观察超声引导下针刀治疗卒中后肩痛的临床疗效。方法 选取76例患者随机分为超声针刀组、传统针刀组,每组38例,超声针刀组采用超声引导下针刀,传统针刀组采用传统针刀治疗,两组均予1次/3 d,每周2次,6 d为1个疗程,疗程间休息1 d,共治疗4个疗程。治疗前后应用疼痛视觉模拟量表评分、Fugl-Meyer上肢运动功能评分、改良Barthel指数、肌骨超声评估临床疗效。结果 与治疗前相比,两组治疗后在视觉模拟评分、Fugl-Meyer上肢运动功能评分、改良Barthel指数均有改善(P <0.05);与传统针刀组相比,超声针刀组视觉模拟评分显著降低(P <0.05),Fugl-Meyer上肢运动功能评分、改良Barthel指数显著升高(P <0.05);两组治疗前后肌骨超声影像差异无统计学意义(P> 0.05);超声针刀组总有效率为97.37%,高于传统针刀组的84.21%(P <0.05)。结论 超声引导下针刀对卒中后肩痛有减轻疼痛、改善上肢功能、提高生活自理能力的作用,疗效优于传统针刀。
关键词(KeyWords): 卒中后肩痛;针刀;超声;可视化
基金项目(Foundation): 厦门市医疗卫生指导性项目(3502Z20199128);; 福建中医药大学校管课题项目(XB2021103);; 厦门市第六批中医后备人才项目
作者(Author): 庄璇,陈德钦,许梅娜,王永,金海鹏,黄源鹏
参考文献(References):
- [1]APRILE I,GERMANOTTA M,CRUCIANI A,et al.Poststroke shoulder pain in subacute patients and its correlation with upper limb recovery after robotic or conventional treatment:Asecondary analysis of a multicenter randomized controlled trial[J].Int J Stroke,2021,16(4):396-405.
- [2]WINSTEIN CJ,STEIN J,ARENA R,et al.Guidelines for adult stroke rehabilitation and recovery:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2016,7(6):e98-e169.
- [3]DYER S,MORDAUNT DA,ADEY-WAKELING Z.Interventions for post-stroke shoulder pain:an overview of systematic reviews[J].Int J Gen Med,2020,13:1411-1426.
- [4]张伯礼,吴勉华.中医内科学[M].4版.北京:中国中医药出版社,2017:205-215.
- [5]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国各类主要脑血管病诊断要点2019[J].中华神经科杂志,2019,52(9):710-715.
- [6]陈飞宇,刘小平,包烨华,等.基于主客配穴的针刺对脑卒中后肩痛及上肢运动功能障碍的影响及相关性分析[J].中国康复医学杂志,2019,7:808-812.
- [7]王月香,曲文春,陈定章,等.肌骨超声诊断(第2版)[M].北京:科技出版社,2020:145-173.
- [8]吴绪平.中国针刀治疗学[M].北京:中国医药科技出版社,2017:42-45,439-441.
- [9]TRAN G,HENSOR E,RAY A,et al.Ultrasound-detected pathologies cluster into groups with different clinical outcomes:data from 3000 community referrals for shoulder pain[J].Arthritis Res Ther,2017,19(1):30.
- [10]蔡桂元,贺涓涓,李娜,等.卒中后偏瘫肩痛患者肩周组织超声影像特点[J].中国康复医学杂志,2019,1:37-42.
- [11]国家中医药管理局.中医病证诊断疗效标准:ZY/Y001.1-94[S].南京:南京大学出版社,1994:36-37.
- [12]ANWER S,ALGHADIR A.Incidence,prevalence,and risk factors of hemiplegic shoulder pain:a systematic review[J].Int J Environ Res Public Health,2020,17(14):4962.
- [13]NADLER M,PAULS M,CLUCKIE G,et al.Shoulder pain after recent stroke(SPARS):hemiplegic shoulder pain incidence within 72 hours post-stroke and 8-10 week follow-up(NCT 02574000)[J].Physiotherapy,2020,107:142-149.
- [14]HOLMES RJ,MCMANUS KJ,KOULOUGLIOTI C,et al.Risk factors for poststroke shoulder pain:a systematic review and Meta-analysis[J].J Stroke Cerebrovasc Dis,2020,29(6):104787.
- [15]吴绪平,彭力,周鹏.针刀医学临床操作规范2021[M].北京:中国医药科学技术出版社,2021:28-38.
- [16]刘夕霞,陈启波,梁辉,等.超声引导下脑卒中后偏瘫肩痛的临床特征及疗效研究[J].广西医科大学学报,2019,43(10):1606-1610.