Abstract:

Objective　To observe the efficacy and safety of Tiaoshen Shujin acupuncture therapy on post-stroke ankle dorsiflexion dysfunction. Methods　A total of 90 patients with post-stroke ankle dorsiflexion dysfunction treated in Shaanxi Provincial Hospital of Traditional Chinese Medicine from March 2022 to February 2024 were prospectively selected and were randomly divided into two groups by the envelope method, with 45 cases in each group. In the feedback group, there were 26 males and 19 females, aged 42-78 (62.24±7.44) years, the stroke duration was 3-12 (7.74±1.24) weeks, and the hemiplegia was on the left side in 21 cases and right side in 24 cases. In the acupuncture group, there were 24 males and 21 females, aged 40-76 (61.94±7.57) years, the stroke duration was 3-12 (7.69±1.30) weeks, and the hemiplegia was on the left side in 23 cases and right side in 22 cases. Both groups were given early rehabilitation training intervention, the feedback group was given myoelectric biofeedback intervention, and the acupuncture group was combined with Tiaoshen Shujin acupuncture therapy on the basis of the feedback group. Both groups were treated continuously for 4 weeks. The gait parameters, active range of motion (AROM) and surface electromyographic indexes of the ankle joints, Fugl-Meyer Assessment Scale for Lower Extremity (FMA-LE) score, Holden Functional Ambulation Category (FAC) score, modified Barthel index (MBI), and clinical spasm index (CSI) were compared between the two groups before and after treatment. Statistical methods used were t test and χ² test. Results　After treatment, the step length, step speed, and step frequency in the acupuncture group were higher than those in the feedback group [(37.44±2.91) cm vs. (34.23±2.58) cm, (57.26±5.82) cm/s vs. (52.84±5.16) cm/s, (69.85±7.04) steps/min vs. (64.46±6.89) steps/min], but the support phase time on the affected side was lower than that in the feedback group [(55.25±5.79)% vs. (58.98±6.42)%], with statistically significant differences (t=5.537, 3.812, 3.671, and 2.894, all P<0.05); the integrated electromyography (iEMG) values of the tibialis anterior muscle and the lateral head of the gastrocnemius muscle in the acupuncture group were higher than those in the feedback group, and the co-contraction ratio (CCR) of dorsiflexion of the affected ankle was lower than that in the feedback group, with statistically significant differences (t=11.913, 4.386, and 3.768, all P<0.05); the scores of FMA-LE, FAC, and MBI and ankle AROM in the acupuncture group were higher than those in the feedback group [(18.69±3.02) points vs. (15.27±2.78) points, (3.71±0.96) points vs. (3.21±0.78) points, (52.64±8.16) points vs. (43.59±7.48) points, (7.23±1.74)° vs. (6.06±1.65)°], but the CSI was lower than that in the feedback group [(8.97±1.24) points vs. (10.34±1.55) points], with statistically significant differences (t=5.589, 3.254, 5.484, 3.273, and 5.589, all P<0.05). The total effective rate of the acupuncture group was higher than that of the feedback group [91.11% (41/45) vs. 75.56% (34/45)], with a statistically significant difference (χ²=3.920, P<0.05). Conclusion　Tiaoshen Shujin acupuncture therapy combined with electromyographic biofeedback intervention can improve ankle dorsiflexion function, walking independence, and therapeutic effect in patients with post-stroke ankle dorsiflexion dysfunction.

Key words:

Stroke, Ankle dorsiflexion dysfunction, Electromyographic biofeedback, Tiaoshen Shujin , acupuncture therapy, Efficacy, Gait parameters

摘要：

目的　观察调神舒筋针刺疗法联合肌电生物反馈对中风后踝关节背屈功能障碍的有效性与安全性。方法　选取2022年3月至2024年2月陕西省中医医院收治的90例中风后踝关节背屈功能障碍患者进行前瞻性研究，采用信封法随机分为两组，每组45例。反馈组：男26例，女19例，年龄42～78（62.24±7.44）岁；中风病程3～12（7.74±1.24）周；偏瘫侧别：左侧21例，右侧24例。针刺组：男24例，女21例，年龄40～76（61.94±7.57）岁；中风病程3～12（7.69±1.30）周；偏瘫侧别：左侧23例，右侧22例。两组均给予早期康复训练干预，反馈组联合肌电生物反馈干预，针刺组在反馈组基础上结合调神舒筋针刺疗法干预。两组均连续治疗4周。比较两组治疗前后步态参数、踝关节主动活动角度（AROM）及表面肌电指标、Fugl-Meyer下肢运动功能评定量表（FMA-LE）评分、Holden步行功能评定量表（FAC）评分、改良Barthel指数（MBI）、临床痉挛指数（CSI）。统计学方法采用t检验、χ²检验。结果　治疗后，针刺组步长、步速、步频均高于反馈组［（37.44±2.91）cm比（34.23±2.58）cm、（57.26±5.82）cm/s比（52.84±5.16）cm/s、（69.85±7.04）步/min比（64.46±6.89）步/min］，患侧支撑相低于反馈组［（55.25±5.79）%比（58.98±6.42）%］，差异均有统计学意义（t=5.537、3.812、3.671、2.894，均P<0.05）；针刺组胫前肌积分肌电值（iEMG）、腓肠肌外侧头iEMG均高于反馈组，患侧踝背屈协同收缩率（CCR）低于反馈组，差异均有统计学意义（t=11.913、4.386、3.768，均P<0.05）；针刺组FMA-LE、FAC、MBI评分及踝关节AROM均高于反馈组［（18.69±3.02）分比（15.27±2.78）分、（3.71±0.96）分比（3.21±0.78）分、（52.64±8.16）分比（43.59±7.48）分、（7.23±1.74）°比（6.06±1.65）°］，CSI低于反馈组［（8.97±1.24）分比（10.34±1.55）分］，差异均有统计学意义（t=5.589、3.254、5.484、3.273、5.589，均P<0.05）。针刺组总有效率高于反馈组［91.11%（41/45）比75.56%（34/45）］，差异有统计学意义（χ²=3.920，P<0.05）。结论　调神舒筋针刺疗法结合肌电生物反馈干预中风后踝关节背屈功能障碍患者，可改善踝背屈功能，提高步行独立性与疗效。

关键词:

中风, 踝关节背屈功能障碍, 肌电生物反馈疗法, 调神舒筋针刺疗法, 疗效, 步态参数