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中华脑科疾病与康复杂志(电子版) ›› 2023, Vol. 13 ›› Issue (03) : 162 -168. doi: 10.3877/cma.j.issn.2095-123X.2023.03.006

临床研究

肌内效贴联合针刺对急性期脑卒中后肩手综合征上肢运动功能康复的临床研究
顾玉玲, 周徐, 马雪梅, 盛卫东, 孙小星, 王海, 俞冲†()   
  1. 226006　江苏南通，南通大学附属南通第三医院康复科
  • 收稿日期:2022-05-15 出版日期:2023-06-15
  • 通信作者: 俞冲

Clinical study on kinesio taping combined with acupuncture on rehabilitation of upper limb motor function in patients with acute poststroke shoulder-hand syndrome

Yuling Gu, Xu Zhou, Xuemei Ma, Weidong Sheng, Xiaoxing Sun, Hai Wang, Chong Yu†()   

  1. Department of Rehabilitation, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226006, China
  • Received:2022-05-15 Published:2023-06-15
  • Corresponding author: Chong Yu
  • Supported by:
    Project of Nantong Science and Technology Bureau(MSZ20098)
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引用本文：

顾玉玲, 周徐, 马雪梅, 盛卫东, 孙小星, 王海, 俞冲. 肌内效贴联合针刺对急性期脑卒中后肩手综合征上肢运动功能康复的临床研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2023, 13(03): 162-168.

Yuling Gu, Xu Zhou, Xuemei Ma, Weidong Sheng, Xiaoxing Sun, Hai Wang, Chong Yu. Clinical study on kinesio taping combined with acupuncture on rehabilitation of upper limb motor function in patients with acute poststroke shoulder-hand syndrome[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2023, 13(03): 162-168.

目的

观察肌内效贴联合针刺疗法对急性期脑卒中后肩手综合征（PSHS）患者上肢运动功能康复的临床疗效。

方法

选取自2019年1月至2022年1月在南通大学附属南通第三医院康复科接受康复治疗的急性期PSHS患者（Ⅰ期）120例，按照随机数字表法分为A组（肌内效贴联合针刺疗法）、B组（肌内效贴治疗）、C组（针刺疗法），每组40例。3组患者均给予内科药物及一般康复作为基础治疗，分别加用肌内效贴和（或）针刺治疗，连续治疗4周。分别于治疗前和治疗4周后采用视觉疼痛评分（VAS）来评价患肢疼痛改善情况，采用Fugl-Meyer运动功能评分上肢部分（FMA-UE）、WOLF运动功能测试（WMFT）评分评价上肢运动功能康复情况。同时参照《康复评定学》的疗效标准来评价肌内效贴联合针刺治疗急性期PSHS患者上肢功能康复的效果。采用多因素二元Logistic回归分析，对性别、年龄及功能评分进行校正后，评估肌内效贴联合针刺对急性期PSHS患者上肢运动功能康复的临床有效性。

结果

3组患者的基线资料及治疗前VAS、FMA-UE、WMFT评分比较，差异均无统计学意义（P>0.05）。治疗4周后，3组患者的VAS评分均有下降，其中A组效果优于B、C组，差异均具有统计学意义（P<0.05）；而FMA-UE、WMFT评分均有升高，其中A组效果优于B、C组，差异均具有统计学意义（P<0.05）。急性期PSHS患者上肢功能康复的总有效率73.33%，其中A组高达90.00%，明显高于B组（67.50%）和C组（62.00%），差异具有统计学意义（P<0.05）。多因素二元Logistic回归分析提示，肌内效贴联合针刺对急性期PSHS患者上肢运动功能改善的临床有效性是单独治疗的6.563倍（95%CI：1.256~34.301，P<0.05）。

结论

肌内效贴联合针刺疗法可促进急性期PSHS患者上肢运动功能康复。

关键词: 脑卒中后肩手综合征, 肌内效贴, 针刺, 运动功能, 康复
Objective

To observe the feasibility and efficacy of kinesio taping combined with acupuncture on rehabilitation of upper limb motor function in patients with acute poststroke shoulder-hand syndrome (PSHS).

Methods

One hundred and twenty patients with acute PSHS (Stage Ⅰ, acute phase) who received rehabilitation treatment at the Rehabilitation Department of Affiliated Nantong Hospital 3 of Nantong University from January 2019 to January 2022 were randomly divided into the A group (kinesio taping combined with acupuncture), B group (kinesio taping), and C group (acupuncture) using a random number table method, with 40 patients in each group. All patients were given internal medicine and general rehabilitation therapy, with continuous treatment for 4 weeks. Visual analogue scale (VAS), Fugl-Meyer motor function assessment of upper limb (FMA-UE) and WOLF motor function test (WMFT) scores were used to evaluate the rehabilitation of upper limb motor function before and after 4 weeks of treatment. At the same time, the efficacy of kinesio taping combined with acupuncture in the treatment of upper limb functional rehabilitation in patients with acute PSHS is evaluated based on the efficacy criteria of the "Rehabilitation Assessment" . Using multivariate binary Logistic regression analysis, after adjusting for gender, age, and functional scores, evaluate the clinical effectiveness of kinesio taping combined with acupuncture in the rehabilitation of upper limb motor function in PSHS patients.

Results

The baseline data and VAS, FMA-UE, WMFT scores were no statistical difference between the three groups before treatment (P>0.05). After 4 weeks of treatment, the VAS scores of all three groups of patients decreased, and the efficacy of group A was better than that of groups B and C, with statistically significant differences (P<0.05); The scores of FMA-UE and WMFT both increased, and the efficacy of group A was better than that of groups B and C, with statistically significant differences (P<0.05). Upper limb functional rehabilitation were evaluated according to rehabilitation assessment, the improvement of limb spasm in the A group (90.00%) was significantly higher than that in the B and C groups (67.50% and 62.00%; P<0.05). Multivariate binary Logistic regression analysis suggests that the clinical efficacy of kinesio taping combined with acupuncture in improving upper limb motor function in acute PSHS patients is 6.563 times higher than that of single treatment (95%CI: 1.256-34.301, P<0.05).

Conclusion

Kinesio taping combined with acupuncture can promote the rehabilitation of upper limb motor function in PSHS patients.

Key words: Poststroke shoulder-hand syndrome, Kinesio taping, Acupuncture, Motor function, Rehabilitation
表1 3组患者的一般资料及治疗前功能评分比较
Tab.1 Comparison of general informations and pretreatment functional scores among three groups
项目 A组（n=40） B组（n=40） C组（n=40） χ2/F/Z值 P值
男性[例（%）] 21（52.5） 22（55.0） 20（50.0） 0.027 0.865
年龄（岁，Mean±SD） 62.01±8.43 58.78±10.12 60.22±9.31 -1.551 0.728
病程[d，M（P25，P75）] 21.20（6.12，42.33） 22.86（7.11，46.26） 20.35（6.68，44.64） 2.278 0.886
缺血性卒中[例（%）] 27（67.50） 24（60.00） 25（62.50） 0.216 0.612
吸烟史[例（%）] 33（82.50） 35（87.50） 34（85.00） 0.062 0.779
饮酒史[例（%）] 30（75.00） 32（80.00） 27（67.50） 0.244 0.538
合并心血管疾病[例（%）] 35（87.50） 33（82.50） 34（85.00） 0.099 0.864
VAS评分-外旋（分，Mean±SD） 6.86±0.82 6.88±0.81 6.79±0.76 5.110 0.911
VAS评分-内旋（分，Mean±SD） 6.75±0.76 6.72±0.73 6.77±0.55 -2.183 0.855
VAS评分-外展（分，Mean±SD） 6.69±0.57 6.65±0.48 6.68±0.34 2.163 0.731
VAS评分-屈曲（分，Mean±SD） 6.98±0.56 6.88±0.45 6.93±0.43 3.256 0.375
FMA-UE评分（分，Mean±SD） 12.50±1.71 11.65±2.60 11.70±2.50 0.775 0.185
WMFT评分（分，Mean±SD） 30.13±3.51 30.18±3.49 30.83±3.93 -3.264 0.634
表2 3组患者肩部活动VAS评分比较（分，Mean±SD）
Tab.2 Comparison of VAS scores in shoulder activity among 3 groups（score, Mean±SD）
项目   A组（n=40） B组（n=40） C组（n=40） F值 P值
外旋 治疗前 6.86±0.82 6.88±0.81 6.79±0.76 36.336 0.911
治疗后 3.26±0.42 4.55±0.22 4.35±0.34 69.334 0.005
t值 -24.713 -17.557 -18.535    
P值 <0.001 <0.001 <0.001    
内旋 治疗前 6.75±0.76 6.72±0.73 6.77±0.55 43.967 0.855
治疗后 3.23±0.24 4.46±0.32 4.42±0.33 79.900 0.004
t值 -27.933 -17.933 -23.172    
P值 <0.001 <0.001 <0.001    
外展 治疗前 6.69±0.57 6.65±0.48 6.68±0.34 48.344 0.731
治疗后 3.12±0.36 4.45±0.44 4.51±0.38 55.117 0.036
t值 -33.491 -21.368 -26.916    
P值 <0.001 <0.001 <0.001    
屈曲 治疗前 6.98±0.56 6.88±0.45 6.93±0.43 49.123 0.375
治疗后 2.45±0.27 4.12±0.16 4.04±0.11 53.565 0.028
t值 -46.084 -35.549 -41.181    
P值 <0.001 <0.001 <0.001    
表3 3组患者FMA-UE及WMFT评分比较（分，Mean±SD）
Tab.3 Comparison of FMA-UE and WMFT scores among 3 groups（score, Mean±SD）
组别 例数 FMA-UE评分 WMFT评分
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
A组 40 12.50±1.71 38.90±4.41 35.300 <0.001 30.13±3.51 45.75±5.11 15.935 <0.001
B组 40 11.65±2.60 26.90±4.84a 17.555 <0.001 30.18±3.49 38.80±4.26a 9.900 <0.001
C组 40 11.70±2.50 27.75±5.01a 18.129 <0.001 30.83±3.93 39.90±3.53a 10.859 <0.001
F值   1.713 79.170     0.458 29.507    
P值   0.185 <0.001     0.634 <0.001    
表4 肌内效贴联合针刺对PSHS患者上肢运动功能康复有效性的多因素二元Logistic回归分析
Tab.4 Multivariate binary Logistic regression analysis of the effectiveness of kinesio taping combined with acupuncture in the rehabilitation of upper limb motor function in PSHS patients
模型 上肢运动功能康复有效（OR值） 95%CI P值
单用组（肌内效贴/针刺） 联合组（肌内效贴+针刺）
Model 1 - 3.113 1.011~18.224 0.008
Model 2 - 4.176 1.303~27.510 0.011
Model 3 - 6.563 1.256~34.301 0.018
[1]
Gao Q, Nie H, Zhu C, et al. Non-pharmaceutical therapy for post-stroke shoulder-hand syndrome: protocol for a systematic and network meta-analysis[J]. Medicine (Baltimore), 2020, 99(23): e20527. DOI: 10.1097/MD.0000000000020527.
[2]
Su YC, Guo YH, Hsieh PC, et al. A Meta-analysis and meta-regression of frequency and risk factors for poststroke complex regional pain syndrome[J]. Medicina (Kaunas), 2021, 57(11): 1232. DOI: 10.3390/medicina57111232.
[3]
Wang TS, Wang SF, Song WD, et al. Effectiveness of extracorporeal shock wave for post-stroke shoulder-hand syndrome: a protocol for systematic review and meta analysis[J]. Medicine (Baltimore), 2020, 99(27): e20664. DOI: 10.1097/MD.0000000000020664.
[4]
叶静,李涓,周俊,等.针灸治疗脑卒中后肩手综合征的meta分析的再评价[J].中国康复医学杂志, 2020, 35(2): 189-194. DOI: 10.3969/j.issn.1001-1242.2020.02.013.
[5]
朱韫钰,祁奇,蒋超,等.肌内效贴结合康复训练治疗脑卒中后肩手综合征的疗效观察[J].中华物理医学与康复杂志, 2019, 41(8): 588-590. DOI: 10.3760/cma.j.issn.0254-1424.2019.08.007.
[6]
中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国各类主要脑血管病诊断要点2019[J].中华神经科杂志, 2019, 52(9): 710-715. DOI: 10.3760/cma.j.issn.1006-7876.2019.09.003.
[7]
王左生,冯晓东.康复医学[M].郑州:郑州大学出版社, 2020: 258-266.
[8]
江伟,袁良津,唐向阳,等.高频重复经颅磁刺激规律间歇治疗丘脑梗死后中枢性疼痛的临床研究[J].中华脑科疾病与康复杂志(电子版), 2022, 12(5): 269-273. DOI: 10.3877/cma.j.issn.2095-123X.2022.05.003.
[9]
Zolkefley MKI, Firwana YMS, Hatta HZM, et al. An overview of fractional anisotropy as a reliable quantitative measurement for the corticospinal tract (CST) integrity in correlation with a Fugl-Meyer assessment in stroke rehabilitation[J]. J Phys Ther Sci, 2021, 33(1): 75-83. DOI: 10.1589/jpts.33.75.
[10]
Martinez C, Bacon H, Rowe V, et al. A reaching performance scale for 2 Wolf motor function test items[J]. Arch Phys Med Rehabil, 2020, 101(11): 2015-2026. DOI: 10.1016/j.apmr.2020.05.003.
[11]
陈立典.康复评定学[M].北京:科学出版社, 2018: 424-431.
[12]
梅照军,陈伟,钱宇,等.血栓成分与脑卒中病因的关系及其对预后的影响[J].中华神经医学杂志, 2021, 20(1): 35-39. DOI: 10.3760/cma.j.cn115354-20200820-00675.
[13]
Diestro JDB, Omar AT, Sarmiento RJC, et al. Cost of hospitalization for stroke in a low-middle-income country: findings from a public tertiary hospital in the Philippines[J]. Int J Stroke, 2021, 16(1): 39-42. DOI: 10.1177/1747493020906872.
[14]
Saha S, Sur M, Ray Chaudhuri G, et al. Effects of mirror therapy on oedema, pain and functional activities in patients with poststroke shoulder-hand syndrome: a randomized controlled trial[J]. Physiother Res Int, 2021, 26(3): e1902. DOI: 10.1002/pri.1902.
[15]
Melese H, Alamer A, Hailu Temesgen M, et al. Effectiveness of kinesio taping on the management of knee osteoarthritis: a systematic review of randomized controlled trials[J]. J Pain Res, 2020, 13: 1267-1276. DOI: 10.2147/JPR.S249567.
[16]
刘阳,李建华,陶静琰,等.运动贴布联合徒手淋巴引流术对脑卒中后肩手综合征及上肢功能疗效观察[J].中国康复医学杂志, 2019, 34(9): 1094-1096. DOI: 10.3969/j.issn.1001-1242.2019.09.017.
[17]
Hsieh HC, Liao RD, Yang TH, et al. The clinical effect of Kinesio taping and modified constraint-induced movement therapy on upper extremity function and spasticity in patients with stroke: a randomized controlled pilot study[J]. Eur J Phys Rehabil Med, 2021, 57(4): 511-519. DOI: 10.23736/S1973-9087.21.06542-4.
[18]
Wang HQ, Hou M, Li H, et al. Effects of acupuncture treatment on motor function in patients with subacute hemorrhagic stroke: a randomized controlled study[J]. Complement Ther Med, 2020, 49: 102296. DOI: 10.1016/j.ctim.2019.102296.
[19]
Zhan J, Xiong B, Zhang P, et al. Abdominal acupuncture as an adjunctive therapy for the recovery of motor function after stroke: a systematic review and meta-analysis of randomized controlled trials[J]. Front Neurol, 2021, 12: 705771. DOI: 10.3389/fneur.2021.705771.
[20]
徐磊,李飞,王敏,等.头针结合悬吊训练治疗脑卒中患者平衡功能障碍:随机对照研究[J].中国针灸, 2021, 41(12): 1308-1312. DOI: 10.13703/j.0255-2930.20201217-0002.
[21]
Zhang ZQ, Li KP, He J, et al. Acupuncture of fascia points to relieve hand spasm after stroke: a study protocol for a multicenter randomized controlled trial[J]. Trials, 2020, 21(1): 69. DOI: 10.1186/s13063-019-3999-7.
[22]
Fan W, Kuang X, Hu J, et al. Acupuncture therapy for poststroke spastic hemiplegia: a systematic review and meta-analysis of randomized controlled trials[J]. Complement Ther Clin Pract, 2020, 40: 101176. DOI: 10.1016/j.ctcp.2020.101176.
[23]
邵锋锋,吴艳,乔姗,等.针刺联合重复经颅磁刺激治疗脑卒中后吞咽障碍的临床研究[J].中华脑科疾病与康复杂志(电子版), 2019, 9(6): 330-334. DOI: 10.3877/cma.j.issn.2095-123X.2019.06.003.
[24]
Cao D, Zhang X, Liu M, et al. Efficacy and safety of manual acupuncture for the treatment of upper limb motor dysfunction after stroke: protocol for a systematic review and meta-analysis[J]. PLoS One, 2021, 16(11): e0258921. DOI: 10.1371/journal.pone.0258921.
[25]
Su XT, Wang L, Ma SM, et al. Mechanisms of acupuncture in the regulation of oxidative stress in treating ischemic stroke[J]. Oxid Med Cell Longev, 2020, 2020: 7875396. DOI: 10.1155/2020/7875396.
[26]
Cao BQ, Tan F, Zhan J, et al. Mechanism underlying treatment of ischemic stroke using acupuncture: transmission and regulation[J]. Neural Regen Res, 2021, 16(5): 944-954. DOI: 10.4103/1673-5374.297061.
[27]
梁繁荣,银子涵.穴性研究的回顾与展望——纪念《中国针灸》创刊40周年[J].中国针灸, 2021, 41(9): 957-960. DOI: 10.13703/j.0255-2930.20210617-0003.
[28]
Gong Y, Li N, Lv Z, et al. The neuro-immune microenvironment of acupoints-initiation of acupuncture effectiveness[J]. J Leukoc Biol, 2020, 108(1): 189-198. DOI: 10.1002/JLB.3AB0420-361RR.
[29]
Molchanova EE, Drobyshev VA. Acupuncture as a factor of correction of «final points» and improving the quality of life at the stage of rehabilitation of patients with ischemic stroke[J]. Vopr Kurortol Fizioter Lech Fiz Kult, 2020, 97(4): 11-16. DOI: 10.17116/kurort20209704111.
[30]
Liu S, Zhang CS, Cai Y, et al. Acupuncture for post-stroke shoulder-hand syndrome: a systematic review and meta-analysis[J]. Front Neurol, 2019, 10: 433. DOI: 10.3389/fneur.2019.00433.
[31]
王瑞奇,吴清忠,黄春华,等. 4种针刺疗法治疗中风后肩手综合征的网状Meta分析[J].中国针灸杂志, 2021, 41(5): 563-569. DOI: 10.13703/j.0255-2930.20200325-k0011.
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