关键肌运动点针刺联合运动训练对脊髓损伤患者的疗效观察

doi:10.11958/20252035

摘要/Abstract

摘要：

目的探讨关键肌运动点针刺联合运动训练对脊髓损伤（SCI）患者神经电生理指标、肢体功能及生活质量的影响。方法选取2022年9月—2024年6月首都医科大学附属北京康复医院康复诊疗中心收治的SCI患者80例，采用随机数字表法分为对照组（予以常规针刺联合运动训练，40例）与观察组（予以关键肌运动点针刺联合运动训练，40例）。比较2组患者干预前、后神经电生理指标[运动神经传导速度（MNCV）、感觉神经传导速度（SNCV）]、肢体功能[Fugl-Meyer评估量表（FMA）、改良Ashworth量表（MAS）]及生活质量[Barthel指数、功能独立性测量（FIM）]。结果干预后，2组正中神经、尺神经、胫神经、腓总神经的MNCV、SNCV水平，FMA评分，Barthel指数，FIM评分均较干预前升高；MAS评分较干预前降低（P<0.05）；且观察组上述各指标变化较对照组显著（P<0.05）。结论关键肌运动点针刺联合运动训练能有效改善SCI患者的神经电生理指标、肢体功能及生活质量，是一种可行的康复干预方案。

关键词: 脊髓损伤, 针刺, 运动（Exercise）, 关键肌, 运动点, 神经电生理

Abstract:

Objective To investigate the effect of acupuncture at key muscle movement points combined with exercise training on neurophysiological indicators, muscle tone and quality of life in patients with spinal cord injury (SCI). Methods Eighty SCI patients admitted to the Rehabilitation Diagnosis and Treatment Center of Beijing Rehabilitation Hospital Affiliated to Capital Medical University from September 2022 to June 2024 were selected. Patients were divided into the control group (receiving routine acupuncture combined with exercise training, 40 cases) and the observation group (receiving acupuncture combined with exercise training at key muscle movement points, 40 cases) according to the random number table method. The neurophysiological indicators [motor nerve conduction velocity (MNCV), sensory nerve conduction velocity (SNCV)], limb function [Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS)] and quality of life [Barthel index, functional independence measure (FIM)] were compared between the two groups. Results After intervention, the MNCV and SNCV of median nerve, ulnar nerve, tibial nerve and common peroneal nerve were increased in the observation group than those in the control group (P<0.05). After intervention, there were higher FMA scores, Barthel index and FIM scores in the observation group than those of the control group, while the MAS score was lower than that of the control group (P<0.05). Conclusion Acupuncture at key muscle movement points combined with exercise training can effectively improve the neuroelectrophysiological indicators, limb functions and quality of life of SCI patients, which is feasible rehabilitation intervention program.

Key words: spinal cord injury, acupuncture, exercise, key muscles, motor point, neurophysiology

中图分类号:

R493

图/表 5

参考文献 18

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组别	年龄/ 岁		性别（男/女）		病程/ 月		受教育年限/年		体质量指数/（kg/m²）
对照组	42.66±2.23		18/22		11.08±1.10		10.73±1.06		21.08±1.10
观察组	42.12±2.17		20/20		11.01±1.05		10.68±1.10		21.11±1.05
t或χ²	1.097		0.201		0.291		0.207		0.125
组别		损伤分级				损伤原因
组别		C级		D级		车祸		坠落		其他外伤
对照组		20（50.00）		20（50.00）		13（32.50）		15（37.50）		12（30.00）
观察组		18（45.00）		22（55.00）		15（37.50）		12（30.00）		13（32.50）
χ²		0.201				0.516

组别	年龄/ 岁		性别（男/女）		病程/ 月		受教育年限/年		体质量指数/（kg/m²）
对照组	42.66±2.23		18/22		11.08±1.10		10.73±1.06		21.08±1.10
观察组	42.12±2.17		20/20		11.01±1.05		10.68±1.10		21.11±1.05
t或χ²	1.097		0.201		0.291		0.207		0.125
组别		损伤分级				损伤原因
组别		C级		D级		车祸		坠落		其他外伤
对照组		20（50.00）		20（50.00）		13（32.50）		15（37.50）		12（30.00）
观察组		18（45.00）		22（55.00）		15（37.50）		12（30.00）		13（32.50）
χ²		0.201				0.516

组别		正中神经					尺神经
组别		干预前		干预后		t	干预前		干预后		t
对照组		39.47±5.17		44.89±5.23		4.661^＊	36.58±5.21		42.99±5.21		5.502^＊
观察组		39.50±5.14		48.07±5.21		7.406^＊	36.54±5.28		46.62±5.27		8.546^＊
t		0.208		2.724^＊			0.034		3.098^＊
组别	胫神经							腓总神经
组别	干预前		干预后		t			干预前		干预后		t
对照组	32.58±5.21		40.93±5.33		7.285^＊			35.58±5.44		41.96±5.17		5.377^＊
观察组	32.54±5.01		44.62±5.22		12.308^＊			35.54±5.41		45.62±5.20		9.339^＊
t	0.035		3.128^＊					0.033		3.157^＊

组别		正中神经					尺神经
组别		干预前		干预后		t	干预前		干预后		t
对照组		39.47±5.17		44.89±5.23		4.661^＊	36.58±5.21		42.99±5.21		5.502^＊
观察组		39.50±5.14		48.07±5.21		7.406^＊	36.54±5.28		46.62±5.27		8.546^＊
t		0.208		2.724^＊			0.034		3.098^＊
组别	胫神经							腓总神经
组别	干预前		干预后		t			干预前		干预后		t
对照组	32.58±5.21		40.93±5.33		7.285^＊			35.58±5.44		41.96±5.17		5.377^＊
观察组	32.54±5.01		44.62±5.22		12.308^＊			35.54±5.41		45.62±5.20		9.339^＊
t	0.035		3.128^＊					0.033		3.157^＊

组别		正中神经					尺神经
组别		干预前		干预后		t	干预前		干预后		t
对照组		39.25±5.20		43.33±5.58		3.383^＊	34.98±5.11		41.98±5.32		6.002^＊
观察组		39.01±5.12		49.10±5.64		8.378^＊	35.50±5.24		45.60±5.26		8.604^＊
t		0.208		4.600^＊			0.449		3.069^＊＊
组别	胫神经							腓总神经
组别	干预前		干预后		t			干预前		干预后		t
对照组	30.58±5.21		38.92±5.24		7.138^＊			32.18±5.36		40.02±5.20		6.640^＊
观察组	30.54±5.11		42.61±5.17		13.982^＊			32.13±5.25		43.62±5.26		9.778^＊
t	0.035		3.170^＊					0.042		3.078^＊