Abstract:

Objective　To analyze the effect of acupotomy under the guidance of meridian tendon theory combined with scalp acupuncture in the treatment of lower limb spasm after stroke and its influences on spasm degree and balance function. Methods　A total of 80 patients with lower limb spasm after stroke admitted to Xi'an International Medical Center Hospital from February 2021 to June 2024 were prospectively selected, and were divided into 2 groups with 40 cases in each group according to the random number table method. There were 20 males and 20 females in the control group, aged (49.20±4.17) years, the spasticity time of lower limb was (10.21±2.63) d, and the hemiplegia site was on the left side in 18 cases and right side in 22 cases. There were 23 males and 17 females in the observation group, aged (49.81±4.37) years, the spasticity time of lower limb was (10.65±3.02) d, and the hemiplegia site was on the left side in 20 cases and right side 20 cases. The control group was treated with scalp acupuncture (once a day, 6 times a week), and the observation group was treated with scalp acupuncture combined with acupotomy under the guidance of meridian tendon theory (3 times a week). Both groups were treated for 4 weeks. The therapeutic effect, adverse reactions, spasticity, balance function, activities of daily living, lower limb motor function, and three-dimensional gait analysis were compared between the two groups. χ² test, rank sum test, and t test were used for statistical analysis. Results　The effective rate of the observation group was 95.00% (38/40), which was higher than that of the control group [77.50% (31/40)] (χ²=5.165, P=0.023). After 4 weeks of treatment, the grade of spasticity in the observation group was better than that in the control group (P<0.05); the modified Barthel index (MBI) [(52.63±3.78) points], Fugl-Meyer Lower Limb Motor Function Rating Scale (FMA-LE) score [(23.20±2.98) points], and Berg Balance Scale (BBS) score [(46.25±5.04) points] in the observation group were higher than those in the control group [(46.21±3.42) points, (20.45±2.68) points, and (41.08±4.59) points] (t=7.965, 4.340, and 4.797, all P<0.05); the step frequency [(73.20±4.99) steps/min] and step speed [(0.61±0.07) m/s] in the observation group were higher than those in the control group [(70.02±4.24) steps/min and (0.52±0.06) m/s] (t=3.071 and 6.174, both P<0.05); the maximum dorsiflexion angle of the affected ankle [(14.02±1.62)°] and the maximum plantar flexion angle of the affected ankle [(20.02±2.74)°] in the observation group were higher than those in the control group [(11.84±1.27)° and (17.21±2.27)°] (t=6.698 and 4.995, both P<0.05). No aggravation occurred in both groups during treatment, and no adverse reactions such as needle fainting, subcutaneous hematoma, or congestion occurred. Conclusion　Acupotomy under the guidance of meridian tendon theory combined with scalp acupuncture has significant therapeutic effect in the treatment of lower limb spasm after stroke, which can reduce the degree of spasm, and improve the gait kinematics parameters, step frequency and pace, and lower limb motor function.

Key words:

Stroke, Spasm of lower limb, Meridian tendon theory, Acupotomy, Scalp acupuncture, Degree of spasm

摘要：

目的　探讨经筋理论指导下针刀联合头针治疗脑卒中后下肢痉挛患者的效果及对痉挛程度和平衡功能的影响。方法　前瞻性选取西安国际医学中心医院2021年2月至2024年6月收治的80例脑卒中后下肢痉挛患者，按随机数字表法为两组，每组40例。对照组男、女各20例；年龄（49.20±4.17）岁；下肢痉挛时间（10.21±2.63）d；偏瘫部位：左侧18例、右侧22例。观察组男、女各23、17例；年龄（49.81±4.37）岁；下肢痉挛时间（10.65±3.02）d；偏瘫部位：左侧20例、右侧20例。对照组应用头针治疗（1次/d，每周6次），观察组应用经筋理论指导下针刀（1周3次）联合头针。两组均治疗4周。比较两组治疗效果、不良反应、痉挛程度、平衡功能、日常生活活动能力、下肢运动功能、三维步态分析结果。采用χ²检验、秩和检验、t检验进行统计学分析。结果　观察组治疗有效率95.00%（38/40）高于对照组77.50%（31/40）（χ²=5.165，P=0.023）。治疗4周后，观察组痉挛程度分级优于对照组（P<0.05）；观察组改良Barthel指数（MBI）［（52.63±3.78）分］、Fugl-Meyer下肢运动功能评定量表（FMA-LE）评分［（23.20±2.98）分］、Berg平衡量表（BBS）评分［（46.25±5.04）分］均高于对照组［（46.21±3.42）分、（20.45±2.68）分、（41.08±4.59）分］（t=7.965、4.340、4.797，均P<0.05）；观察组步频［（73.20±4.99）步/min］、步速［（0.61±0.07）m/s］均高于对照组［（70.02±4.24）步/min、（0.52±0.06）m/s］（t=3.071、6.174，均P<0.05）；观察组患侧踝关节最大背屈角度［（14.02±1.62）°］、患侧踝关节最大跖屈角度［（20.02±2.74）°］均大于对照组［（11.84±1.27）°、（17.21±2.27）°］（t=6.698、4.995，均P<0.05）。两组患者治疗过程中均未出现加重情况，也未出现晕针、皮下血肿、淤血等不良反应。结论　脑卒中后下肢痉挛患者采取经筋理论指导下针刀联合头针治疗效果显著，可降低痉挛程度分级，改善步态运动学参数、步频和步速、下肢运动功能。

关键词:

脑卒中, 下肢痉挛, 经筋理论, 针刀, 头针, 痉挛程度