目的: 探究神经松动术联合头体针巨刺法应用于卒中后偏瘫患者的效果。方法: 选取2019年1月至2021年8月多中心收治的126例卒中后偏瘫患者,按照治疗方案不同随机分为联合组(n=42)、头体针组(n=42),神经松动组(n=42),头体针组患者进行头体针巨刺法,神经松动组进行手法神经松动术,联合组患者在进行头体针巨刺法基础上进行手法神经松动术;3组患者在治疗前、治疗后4周、8周进行美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评估神经功能,Berg平衡量表(Berg Balance Scale,BBS)评估肢体平衡功能,采用肌电图诱发电位仪检测患侧正中神经波幅、阈值,并应用Fugl-Meyer运动功能评定量表(Fugl-MeyerAssessmentScale,FMAS)评估肢体运动功能,barthel指数(Modified barthel index,MBI)评分、计时起立-行走测试(Time Up and Go Test,TUGT)评分评估日常活动能力。结果: 与同组治疗前相比,治疗后4周、8周时3组患者的NIHSS评分、水肿分级评分、肩部疼痛VAS评分均降低(各项均P＜0.05),BBS评分、上肢运动、下肢运动评分、MBI评分均升高(各项均P＜0.05);患侧正中神经F波阈值降低,F波波幅升高,TUGT时间缩短(P＜0.05);组间相比,治疗4周、8周后联合组NIHSS评分较头体针组、神经松动组低(P＜0.05),BBS评分、肢体运动功能评分较头体针组、神经松动组高(P＜0.05);联合组患侧正中神经F波阈值低于头体针组、神经松动组(P＜0.05);F波波幅高于头体针组、神经松动组(P＜0.05);联合组水肿分级评分、肩部疼痛VAS评分较头体针组、神经松动组低(P＜0.05);联合组TUGT时间短于头体针组、神经松动组,MBI评分较头体针组、神经松动组高(P＜0.05)。结论: 头体针巨刺法与神经松动术联合应用于卒中后偏瘫可有效缓解神经损伤,促进肢体运动功能恢复,提高平衡功能及日常活动能力。

Objective: To investigate the effect of nerve mobilization combined with head and body needling on patients with hemiplegia after stroke. Methods: A total of 126 patients with post-stroke hemiplegia admitted to multiple centers from January 2019 to August 2021 were randomly divided into the combined group (n=42), the head and body acupuncture group (n=42), and the nerve loosening group (n=42) according to different treatment plans. The patients in the head and body acupuncture group underwent giant acupuncture with head and body acupuncture, and the nerve loosening group underwent manipulative nerve loosening. Patients in the combined group underwent manipulative nerve loosening on the basis of head and body acupuncture. Before treatment, 4 weeks and 8 weeks after treatment, neurological function was assessed by the National Institute of Health stroke scale (NIHSS) and Berg Balance Scale (BBS) was used to assess the balance function of the limbs. The amplitude and threshold of the median nerve of the affected side were measured by electromyographic evoked potentiometer, and the motor function of the limbs was assessed by Fugl-Meyer Motor Function Assessment Scale (FMAS). Daily activity ability was assessed by the Modified barthel index (MBI) score and the Time Up and Go Test (TUGT) score. Results: Compared with the same group before treatment, the NIHSS scores, edema grading scores, shoulder pain and hand pain VAS scores of the patients in the three groups at 4 and 8 weeks after treatment decreased, while the BBS scores, upper limb movement scores, lower limb movement scores and MBI scores increased (all P＜0.05); The median nerve F wave threshold decreased, F wave amplitude increased, and TUGT time shortened (P＜0.05). After 4 and 8 weeks of treatment, the NIHSS score of the combined group was lower than that of the head and body acupuncture group and nerve loosening group (P＜0.05), and the BBS score and limb motor function score were higher than that of the head and body acupuncture group and nerve loosening group (P＜0.05). The F wave threshold of the affected median nerve in the combined group was lower than that of the head needle and nerve loosening groups, and the F wave amplitude was higher than that of the head needle and nerve loosening group (P＜0.05). The edema grading score, shoulder pain VAS score in the combined group were lower than those in the head and body acupuncture group and nerve loosening group (P＜0.05). The TUGT time of the combined group was shorter than that of the head body acupuncture group and the nerve loosening group, and the MBI score was higher than that of the head body acupuncture group and the nerve loosening group (P＜0.05). Conclusion: The combined application of head and body acupuncture and nerve mobilization in post-stroke hemiplegia can effectively alleviate the nerve injury, promote the recovery of limb motor function, and improve the balance function and daily activity ability.