Abstract:

Objective　To explore the curative effect of acupuncture and moxibustion combined with proprioceptive neuromuscular facilitation (PNF) for patients with limb dysfunction after stroke. Methods　Ninety-eight patients with limb dysfunction after stroke admitted to Liaocheng Third People's Hospital from January 2022 to January 2023 were selected for the randomized controlled trial. They were divided into a single group and an experimental group by the random number table method, with 49 patients in each group. There were 30 males and 19 females in the single group; they were (62.67±6.71) years old. There were 29 males and 20 females in the experimental group; they were (63.75±6.76) years old. The single group were treated with PNF, and the experimental group with PNF, acupuncture, and moxibustion. The total clinical response rates and related scores [Berg Balance Scale (BBS), Neurological Deficit Scale (NIHSS), Modified Barthel Index (MBI), and Functional Comprehensive Assessment Scale (FCA)], limb function [Free Hand Muscle Strength Scale (MMT) and Fugl Meyer Motor Function Score (FMA)], and gait spatiotemporal parameters (stride speed, stride length, stride frequency, affected side swing phase, affected side support phase, and bilateral support phase level), and kinematic parameters [peak joint torque (hip, knee, and ankle) and maximum flexion and extension angle (hip and knee)] before and after the treatment were compared between the two groups. t and χ² tests were applied. Results　The total clinical effective rate after the treatment of the experimental group was higher than that of the single group [95.92% (47/49) vs. 79.59% (39/49)], with a statistical difference (χ²=4.653; P=0.031). The scores of FCA, MBI, BBS, and NIHSS in the experimental group were (65.19±4.23), (73.82±8.56), (43.18±3.45), and (3.15±1.17); the scores in the single group were (61.86±5.35), (66.79±5.98), (34.59±2.80), and (5.27±2.38); there were statistical differences between the two groups (t=3.418, 4.713, 13.533, and 5.596; all P<0.05). After the treatment, the scores of upper and lower limb FAM and MMT in the experimental group were higher than those in the single group [(55.79±6.55) vs. (49.65±5.25), (27.06±3.67) vs. (24.68±3.35), and (4.07±0.62) vs. (3.46±0.87)], with statistical differences (t=5.120, 3.353, and 3.997; all P<0.05). After the treatment, the stride frequency, stride length, stride speed, and affected side swing phase level in the experimental group were higher than those in the single group [(107.76±10.96) steps/min vs. (95.19±9.25) steps/min, (40.67±6.48) cm vs. (36.50±5.71) cm, (0.63±0.13) m/s vs. (0.45±0.11) m/s, and (42.84±6.01)% vs. (39.76±5.24)%]; the levels of the affected side support phase and bilateral support phase in the experimental group were lower than those in the single group [(57.21±5.01)% vs. (61.89±5.06)% and (31.16±6.11)% vs. (37.46±7.06)%]; there were statistical differences (t=6.135, 3.380, 7.399, 2.704, 4.601, and 4.723; all P<0.05). After the treatment, the peak torque of hip joint, the maximum flexion and extension angle of hip joint, the peak torque of knee joint, the maximum flexion and extension angle of knee joint, and the peak torque of ankle joint in the experimental group were bigger than those in the single group [(0.64±0.13) Nm vs. (0.55±0.11) Nm, (34.35±7.09)° vs. (29.64±6.71)°, (1.59±0.32) Nm vs. (1.37±0.31) Nm, (49.46±8.02)° vs. (42.98±7.61)°, and (1.59±0.27) Nm vs. (1.45±0.24) Nm], with statistical differences (t=3.700, 3.378, 3.457, 4.103, and 2.713; all P<0.05). Conclusion　Acupuncture and moxibustion + PNF for patients with limb dysfunction after stroke can improve the curative effect and their limb muscle strength, balance ability, motor function, walking ability, nerve injury, and quality of life.

Key words:

Stroke, Proprioception neuromuscular facilitation technology, Acupuncture and moxibustion, Limb dysfunction, Gait spatiotemporal,  , Kinematics characteristics

摘要：

目的　探讨针灸联合本体感觉神经肌肉促进技术（PNF）对脑卒中后肢体功能障碍患者的疗效。方法　本文为随机对照试验，选取2022年1月至2023年1月聊城市第三人民医院收治的98例脑卒中后肢体功能障碍患者作为研究对象，依据随机数字表法分为单一组和试验组，各49例。单一组男30例、女19例，年龄（62.67±6.71）岁，采取PNF治疗；试验组男29例、女20例，年龄（63.75±6.76）岁，采取PNF+针灸治疗。对比两组患者临床总有效率、治疗前后相关评分［Berg平衡量表（BBS）、美国国立卫生研究院卒中量表（NIHSS）、改良Barthel指数（MBI）、功能综合评定量表（FCA）］水平、肢体功能［徒手肌力量表（MMT）、Fugl-Meyer运动功能评分（FMA）］水平、步态时空参数（步速、步长、步频、患侧摆动相、患侧支撑相、双侧支撑相水平）及运动学参数［关节力矩峰值（髋、膝、踝）、最大屈伸角度（髋、膝）］水平。统计学方法采用t检验、χ²检验。结果　试验组治疗后临床总有效率为95.92%（47/49），高于单一组的79.59%（39/49），差异有统计学意义（χ²=4.653，P=0.031）。治疗后，试验组FCA、MBI及BBS评分［（65.19±4.23）分、（73.82±8.56）分、（43.18±3.45）分］均高于单一组［（61.86±5.35）分、（66.79±5.98）分、（34.59±2.80）分］，NIHSS评分［（3.15±1.17）分］低于单一组［（5.27±2.38）分］，差异均有统计学意义（t=3.418、4.713、13.533、5.596，均P<0.05）。治疗后，试验组上肢FMA、下肢FMA评分及MMT［（55.79±6.55）分、（27.06±3.67）分、（4.07±0.62）级］均高于单一组［（49.65±5.25）分、（24.68±3.35）分、（3.46±0.87）级］，差异均有统计学意义（t=5.120、3.353、3.997，均P<0.05）。治疗后，试验组步频、步长、步速及患侧摆动相水平［（107.76±10.96）步/min、（40.67±6.48）cm、（0.63±0.13）m/s、（42.84±6.01）%］均高于单一组［（95.19±9.25）步/min、（36.50±5.71）cm、（0.45±0.11）m/s、（39.76±5.24）%］，患侧支撑相及双侧支撑相水平［（57.21±5.01）%、（31.16±6.11）%］均低于单一组［（61.89±5.06）%、（37.46±7.06）%］，差异均有统计学意义（t=6.135、3.380、7.399、2.704、4.601、4.723，均P<0.05）。治疗后，试验组髋关节力矩峰值、髋关节最大屈伸角度、膝关节力矩峰值、膝关节最大屈伸角度、踝关节力矩峰值［（0.64±0.13）Nm、（34.35±7.09）°、（1.59±0.32）Nm、（49.46±8.02）°、（1.59±0.27）Nm］均高于单一组［（0.55±0.11）Nm、（29.64±6.71）°、（1.37±0.31）Nm、（42.98±7.61）°、（1.45±0.24）Nm］，差异均有统计学意义（t=3.700、3.378、3.457、4.103、2.713，均P<0.05）。结论　针灸+PNF治疗脑卒中后肢体功能障碍可提高疗效，增强患者肢体肌力、平衡能力及运动功能，改善步行能力及神经损伤，提高患者生活质量。

关键词:

脑卒中, 本体感觉神经肌肉促进技术, 针灸, 肢体功能障碍, 步态时空, 运动学特征