温通穴位灸刮疗法联合康复疗法治疗脑卒中后上肢痉挛性瘫痪临床研究

Clinical Study of Warming and Unblocking Acupoint Moxibustion-Scraping Therapy Combined with Rehabilitation Therapy for Post-Stroke Upper Limb Spastic Paralysis

摘要:

目的：观察温通穴位灸刮疗法联合康复疗法治疗脑卒中后上肢痉挛性瘫痪患者的疗效。方法：选取2023年11月—2025年3月浙江中医药大学附属金华中医院康复科收治的138例脑卒中后上肢痉挛性瘫痪患者作为观察对象，采用随机数字表法分为对照组与观察组各69例。对照组实施常规康复疗法，观察组在常规康复疗法基础上联合温通穴位灸刮疗法治疗。2组均治疗8周。治疗前后评估患侧上肢的痉挛程度［临床痉挛指数（CSI） 评分］、运动功能［Wolf 运动功能测试（WMFT） 评分， Fugl-Meyer 上肢运动功能评估量表（FMA-UE） 评分］、肌力［徒手肌力检查（MMT） 评分］，检测前臂伸肌群、三角肌和肱三头肌的表面肌电信号值。比较2组的临床疗效。结果：治疗8周后，观察组总有效率高于对照组（P＜0.05）。2组CSI评分均随治疗时间的延长呈下降趋势。2组组内治疗前及治疗2周、4周、8周后的CSI评分整体比较，差异均有统计学意义（P＜0.05）。治疗2周、4周、8周后的CSI评分均较治疗前下降（P＜0.05），治疗4周后的CSI评分均较治疗2周后下降（P＜0.05），治疗8周后的CSI评分均较治疗4周后下降（P＜0.05）。观察组治疗2周、4周、8周后的CSI评分均低于对照组（P＜0.05）。2组FMA-UE评分、MMT评分以及前臂伸肌群、三角肌和肱三头肌的表面肌电信号值均随治疗时间的延长呈上升趋势。2组组内治疗前及治疗2周、4周、8周后的5项指标值整体比较，差异均有统计学意义（P＜0.05）。2组治疗2周、4周、8周后的5项指标值均较治疗前上升（P＜0.05），治疗4周后的5项指标值均较治疗2周后上升（P＜0.05），治疗8周后的5项指标值均较治疗4周后上升（P＜0.05）；观察组治疗2周、4周、8周后的5项指标值均高于对照组（P＜0.05）。结论：采用温通穴位灸刮疗法联合常规康复疗法治疗脑卒中后上肢痉挛性瘫痪，可进一步减轻患肢的痉挛程度，促进患肢运动功能、肌力的恢复，增强肌肉收缩效率与协调性，进而促进患肢整体肌肉功能的恢复。

Abstract:

138 patients with post-stroke upper limb spastic paralysis admitted to the Department of Rehabilitation， Jinhua Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University， from November 2023 to March 2025， were enrolled and randomly divided into a control group and an observation group using a random number table method， with 69 cases in each group. The control group received conventional rehabilitation therapy， while the observation group received warming and unblocking acupoint moxibustion-scraping therapy on the basis of the conventional rehabilitation therapy. Both groups were treated for eight weeks. Before and after treatment， the spasticity [Clinical Spasticity Index （CSI） scores]，motor function [Wolf Motor Function Test （WMFT） scores，Fugl- Meyer Assessment of Upper Extremity （FMA-UE） scores]， and muscle strength [Manual Muscle Testing （MMT） scores] of patients were assessed. Surface electromyographic （sEMG） signals of the forearm extensor muscles，deltoid， and triceps brachii were recorded. The clinical efficacy of the two groups was compared. Results：After eight weeks of treatment，the total effective rate in the observation group was significantly higher than that in the control group （P＜ 0.05）. The CSI scores in both groups showed a decreasing trend over the treatment duration. Within each group，there were statistically significant differences in CSI scores across the four time points （before treatment，and at two，four， and eight weeks of treatment） （P＜0.05）. In both groups， CSI scores at two， four， and eight weeks after treatment were significantly decreased compared with those before treatment （P＜0.05）；scores at four weeks after treatment were lower than those at two weeks after treatment （P＜0.05）；and scores at eight weeks after treatment were lower than those at four weeks after treatment （P＜0.05）. At two， four， and eight weeks after treatment， the CSI scores in the observation group were significantly lower than those in the control group at the corresponding time points （P＜0.05）. Similarly， the FMA-UE scores， MMT scores， and sEMG signals of the forearm extensor muscles， deltoid， and triceps brachii in both groups showed increasing trends over time. Within each group， significant differences were observed across the four time points for all five indicators （P＜0.05）. Compared with those before treatment， all five indicators in both groups increased significantly at two， four， and eight weeks after treatment （P＜0.05）； values at four weeks after treatment were higher than those at two weeks after treatment （P＜0.05）； and values at eight weeks after treatment were higher than those at four weeks after treatment （P＜0.05）. The observation group demonstrated significantly higher values for all five indicators than the control group at two， four， and eight weeks after treatment （P＜0.05）. Conclusion： The combination of warming and unblocking acupoint moxibustion-scraping therapy and rehabilitation therapy for post-stroke upper limb spastic paralysis can further alleviate spasticity，promote the recovery of motor function and muscle strength， enhance muscle contraction efficiency and coordination， and thereby facilitate the overall functional recovery of the affected upper limb.